Medscape is available in 5 Language Editions – Choose your Edition here.


Borderline Personality Disorder Medication

  • Author: Roy H Lubit, MD, PhD; Chief Editor: Caroly Pataki, MD  more...
Updated: May 18, 2016

Medication Summary

In the treatment of borderline personality disorder (BPD), selective serotonin reuptake inhibitors (SSRIs) are greatly preferred to the other classes of antidepressants. Benzodiazepines are contraindicated in this population because they reduce inhibitions and are therefore likely to increase impulsivity. Antipsychotic agents and opiate receptor antagonists may also be considered.


Selective Serotonin Reuptake Inhibitors (SSRIs)

Class Summary

SSRIs are chemically unrelated to the tricyclic, tetracyclic, and other available antidepressants. They inhibit neuronal reuptake of serotonin in the central nervous system (CNS) and may have a weak effect on neuronal reuptake of norepinephrine and dopamine. SSRIs are also used to treat anxiety, phobias, and obsessive-compulsive disorder (OCD).

At high dosages, SSRIs appear to reduce impulsivity and aggression; however, their antidepressant effects are less impressive than those of other drugs. Because the adverse effect profile of SSRIs is less prominent, improved compliance is promoted. SSRIs do not have the cardiac arrhythmia risk associated with tricyclic antidepressants.

Fluoxetine (Prozac)


Fluoxetine selectively inhibits presynaptic serotonin reuptake, with minimal or no effect on norepinephrine or dopamine uptake. It was the first available SSRI and remains the prototype. Of all the SSRIs, it has the longest half-life (72 hours). Commonly reported adverse effects (eg, general insomnia, agitation, and gastrointestinal [GI] disturbance) are generally well tolerated, and discontinuance by the patient is rare.

The dosage should be increased only if improvement is not evident. A trial of 6-8 weeks may be required before resistance is inferred. Higher dosages are generally more effective in BPD. Fluoxetine is approved by the US Food and Drug Administration (FDA) for treatment of depression and OCD in children and adolescents.

Sertraline (Zoloft)


Sertraline has a shorter half-life (25 hours) and fewer reported adverse effects than fluoxetine. It does not increase plasma levels of other psychotropic medications to the same extent that fluoxetine does. The most commonly reported adverse effects are generally well tolerated; discontinuance by the patient is rare. Sertraline is FDA-approved for OCD in children older than 6 years and for posttraumatic stress disorder (PTSD) in adults. An oral liquid concentrate is available.

Paroxetine (Paxil, Pexeva)


Paroxetine is a potent selective inhibitor of neuronal serotonin reuptake. It also has a weak effect on norepinephrine and dopamine neuronal reuptake.

Escitalopram (Lexapro)


This agent is an SSRI and an S-enantiomer of citalopram that is used for the treatment of depression. Escitalopram enhances serotonin activity because of selective reuptake inhibition at the neuronal membrane. Its mechanism of action is thought to be the potentiation of serotonergic activity in the central nervous system (CNS) through the inhibition of CNS neuronal reuptake of serotonin. The onset of depression relief may occur after 1-2 weeks, which is faster than the relief obtained from other antidepressants.

Fluvoxamine (Luvox CR)


Fluvoxamine is a potent selective inhibitor of neuronal serotonin reuptake. It does not significantly bind to alpha-adrenergic, histamine, or cholinergic receptors and thus has fewer adverse effects than TCAs do. In the treatment of BDD, higher doses than those used for depression generally are needed. Fluvoxamine is FDA-approved for children with OCD.



Class Summary

Low-dose neuroleptics are effective in the short term for control of transient psychotic symptoms. Antipsychotics have long been used to control impulsivity and aggression in patients with BPD, although SSRIs are preferred because of their more benign adverse effect profile.

Low-dose neuroleptics are effective in the short term for control of transient psychotic symptoms. Antipsychotics have long been used to control impulsivity and aggression in patients with BPD, although SSRIs are preferred because of their more benign adverse effect profile.

Risperidone (Risperdal)


Risperidone binds to dopamine D2 receptors with an affinity 20 times lower than its affinity for the serotonin 5-HT2 receptor. It improves negative symptoms of psychoses and reduces the incidence of extrapyramidal adverse effects. Risperidone is FDA-approved for several indications in pediatric patients: schizophrenia in adolescents (13-17 years), bipolar mania in children and adolescents (10-17 years), and irritability associated with autistic disorder in children (5-16 years). It is available as an oral solution.

Olanzapine (Zyprexa)


Olanzapine may inhibit the effects of serotonin, muscarine, and dopamine.

Quetiapine (Seroquel)


Quetiapine may act by antagonizing the effects of dopamine and serotonin. Its efficacy is similar to that of risperidone and olanzapine. This agent causes fewer dose-dependent adverse effects and less concern regarding weight gain.


Opiate Receptor Antagonists

Class Summary

In small studies and case reports, opiate receptor antagonists have been reported to reduce the duration and intensity of dissociative symptoms in patients with BPD and to decrease self-injurious behavior. Evidence suggests that alterations of the endogenous opiate systems contribute to dissociative symptoms in patients with BPD.

Naltrexone (ReVia, Vivitrol)


Naltrexone is a cyclopropyl derivative of oxymorphone that acts as a competitive antagonist at opioid receptors.

Contributor Information and Disclosures

Roy H Lubit, MD, PhD Private Practice

Roy H Lubit, MD, PhD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.


Elizabeth A Finley-Belgrad, MD Clinical Assistant Professor, Department of Psychiatry, Northeastern Ohio Universities College of Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

  1. Linehan MM, Heard HL, Armstrong HE. Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients [published erratum appears in Arch Gen Psychiatry 1994 May;51(5):422]. Arch Gen Psychiatry. 1993 Dec. 50(12):971-4. [Medline].

  2. Linehan MM, Tutek DA, Heard HL, Armstrong HE. Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients. Am J Psychiatry. 1994 Dec. 151(12):1771-6. [Medline].

  3. Pine F. A working nosology of borderline syndromes in children. The Borderline Child. New York, NY: McGraw Hill; 1982. 83.

  4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th ed. Arlington, VA: American Psychiatric Association; 2013. 663-6.

  5. Sansone RA, Sansone LA. The Relationship Between Borderline Personality and Obesity. Innov Clin Neurosci. 2013 Apr. 10(4):36-40. [Medline]. [Full Text].

  6. Bernhardt K, Friege L, Gerok-Falke K, Aldenhoff JB. [In-patient treatment concept for acute crises of borderline patients on the basis of dialectical-behavioral therapy]. Psychother Psychosom Med Psychol. 2005 Sep. 55(9-10):397-404. [Medline].

  7. Hanson G, Bemporad JR, Smith HF, Chicchetti D. The day and residential treatment of the borderline child. The Borderline Child. New York, NY: McGraw Hill; 1982. 235.

  8. Bohus MJ, Landwehrmeyer GB, Stiglmayr CE, et al. Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: an open-label trial. J Clin Psychiatry. 1999 Sep. 60(9):598-603. [Medline].

  9. Schroeder K, Fisher HL, Schäfer I. Psychotic symptoms in patients with borderline personality disorder: prevalence and clinical management. Curr Opin Psychiatry. 2013 Jan. 26 (1):113-9. [Medline].

  10. Deutsch H. Some forms of emotional disturbance and their relationship to schizophrenia. 1942. Psychoanal Q. 2007 Apr. 76(2):325-44; discussion 345-86. [Medline].

  11. Kernberg OF. Borderline Conditions and Pathological Narcissism. New York, NY: Aronson; 1975.

  12. Marcus J, Ovsiew F, Hans S. Neurological dysfunction in borderline children. The Borderline Child. New York, NY: McGraw Hill; 1982. 171.

  13. De la Fuente JM, Tugendhaft P, Mavroudakis N. Electroencephalographic abnormalities in borderline personality disorder. Psychiatry Res. 1998 Feb 9. 77(2):131-8. [Medline].

  14. Baird AA, Veague HB, Rabbitt CE. Developmental precipitants of borderline personality disorder. Dev Psychopathol. 2005 Fall. 17(4):1031-49. [Medline].

  15. Mahler M, Ross J, Defries Z. Clinical studies in benign and malignant cases of childhood psychosis. Am J Orthopsychiatry. 1949. 19:295.

  16. Combrinck-Graham L. The borderline syndrome in childhood: a family systems approach. J Psychother Fam. 1989. 5:31-34.

  17. Clarkin JF, Widiger TA, Frances A, et al. Prototypic typology and the borderline personality disorder. J Abnorm Psychol. 1983 Aug. 92(3):263-75. [Medline].

  18. Ørts Clemmensen LM1, Olrik Wallenstein Jensen S, Zanarini MC, Skadhede S, Munk-Jørgensen P. Changes in treated incidence of borderline personality disorder in denmark: 1970-2009. Can J Psychiatry. 2013. 58(9):522-8.

  19. Nasiri H, Abedi A, Ebrahimi A, Ameli SS, Samouei R. Personality profile of women affected with borderline personality disorder. Mater Sociomed. 2013. 25(1):60-3. [Medline]. [Full Text].

  20. Links PS, Heslegrave R, van Reekum R. Prospective follow-up study of borderline personality disorder: prognosis, prediction of outcome, and Axis II comorbidity. Can J Psychiatry. 1998 Apr. 43(3):265-70. [Medline].

  21. Andrulonis PA. Paper presented at: Annual Meeting of the American Psychiatric Association. Borderline personality subcategories in children. 1990.

  22. Zimmerman M, Mattia JI. Axis I diagnostic comorbidity and borderline personality disorder. Compr Psychiatry. 1999 Jul-Aug. 40(4):245-52. [Medline].

  23. Weil A. Certain severe disturbances of ego development in children. Psychoanal Study Child. 1953. 8:271.

  24. Freud A. The assessment of borderline cases. The Writings of Anna Freud. New York, NY: International Universities Press; 1969. Vol 5:

  25. Schuermann B, Kathmann N, Stiglmayr C, Renneberg B, Endrass T. Impaired decision making and feedback evaluation in borderline personality disorder. Psychol Med. 2011 Sep. 41(9):1917-27. [Medline].

  26. Block MJ, Westen D, Ludolph P, et al. Distinguishing female borderline adolescents from normal and other disturbed female adolescents. Psychiatry. 1991 Feb. 54(1):89-103. [Medline].

  27. Skodol AE, Grilo CM, Keyes KM, Geier T, Grant BF, Hasin DS. Relationship of personality disorders to the course of major depressive disorder in a nationally representative sample. Am J Psychiatry. 2011 Mar. 168(3):257-64. [Medline].

  28. Marsha M. Linehan PhD. DBT® Skills Training Manual, Second Edition. Guilford; 2014.

  29. Linehan MM, Korslund KE, Harned MS, Gallop RJ, Lungu A, Neacsiu AD, et al. Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis. JAMA Psychiatry. 2015 May. 72 (5):475-82. [Medline].

  30. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. 2006 Jan. 163(1):41-7. [Medline]. [Full Text].

  31. McClellan J, Sikich L, Findling RL, et al. Treatment of early-onset schizophrenia spectrum disorders (TEOSS): rationale, design, and methods. J Am Acad Child Adolesc Psychiatry. 2007 Aug. 46(8):969-78. [Medline].

  32. Meighen KG, Hines LA, Lagges AM. Risperidone treatment of preschool children with thermal burns and acute stress disorder. J Child Adolesc Psychopharmacol. 2007 Apr. 17(2):223-32. [Medline].

  33. Armenteros JL, Lewis JE, Davalos M. Risperidone augmentation for treatment-resistant aggression in attention-deficit/hyperactivity disorder: a placebo-controlled pilot study. J Am Acad Child Adolesc Psychiatry. 2007 May. 46(5):558-65. [Medline].

  34. White T, Schultz SK. Naltrexone treatment for a 3-year-old boy with self-injurious behavior. Am J Psychiatry. 2000 Oct. 157(10):1574-82. [Medline].

  35. Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Time to attainment of recovery from borderline personality disorder and stability of recovery: A 10-year prospective follow-up study. Am J Psychiatry. 2010 Jun. 167(6):663-7. [Medline].

  36. Gunderson JG, Stout RL, McGlashan TH, et al. Ten-year course of borderline personality disorder: psychopathology and function from the collaborative longitudinal personality disorders study. Arch Gen Psychiatry. 2011 Aug. 68(8):827-37. [Medline]. [Full Text].

  37. Feliu-Soler A, Pascual JC, Borràs X, Portella MJ, Martín-Blanco A, Armario A, et al. Effects of Dialectical Behaviour Therapy-Mindfulness Training on Emotional Reactivity in Borderline Personality Disorder: Preliminary Results. Clin Psychol Psychother. 2013 Mar 14. [Medline].

  38. Thomsen MS Ruocco AC, Uliaszek AA Mathiesen BB1, Simonsen E. Changes in Neurocognitive Functioning After 6 Months of Mentalization-Based Treatment for Borderline Personality Disorder. J Pers Disord. 2016. 1-19.

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.