At one point, someone emailed me regarding a topic that I was shocked to realize I actually read/write very little about even though it can be massively important to the treatment of mental illness: meds!
Maybe it’s me not looking hard enough (in fact I’m sure it is) but I really don’t know a whole lot about the BPD community’s general stance on medication for this disorder. Perhaps that’s for the simple and valid reason that there is no consensus at this point – not among doctors, patients, or anyone else – that BPD should be treated with medication, and, if so, with which medication.
So here are my personal medication stats and story:
Firstly, I was EXTREMELY resistant to the idea of meds. I mean I know that’s probably most people: “What if it changes me? What if I become reliant on it? What if it has horrible side effects?” All totally valid and I am still far from the world’s biggest pill-happy medication advocate. I think there is a lot more to be learned about the way anti-depressants and anti-psychotics work (which no one still really gets) and, especially, why the same medications can have the exact opposite effect in some patients. I completely get the vague fear that medication is an “outside” force that will dilute your “inside” self, and it’s important to acknowledge that fear. For those reasons, I remain conflicted.
However.
I ultimately decided to give meds a try because my concerns did not outweigh the possible benefits. For example:
“What if it changes me?”
Realistically, and as much as part of me fights it sometimes, I want to change – a lot. It’s not diluting yourself when you eat protein to make you stronger. It’s not diluting yourself when you take a tylenol to deal with a temporary headache or some menstrual cramps. And if I do notice the drug changing me for the worse, I will stop taking it.
“What if I become reliant on it?”
I’m already completely reliant on self-harm, alcohol, terrible relationships, illegal drugs and dangerous activities: I’m kidding myself if I think I’d be giving up any level of free will by taking a couple prescribed pills a day instead.
So I put myself in the hands of the doctors assigned to me and, sadly, was quite disappointed. At least for what seemed like an unnecessarily long time. First it was an anti-depressant called Ciprilex and some antipsychotics (unfortunately, I can’t remember the names of those…). The former made me feel a whopping 0% better and made me gain a bit of weight. The latter made me feel numb, out-of-it and paranoid.
My second run was with another anti-depressant called Cymbalta. No terrible side effects that I could detect, but it didn’t do any good either.
The third try (this was over a year into trying stuff, as you have to give all meds time to work) was an anti-depressant called Wellbutrin. I hate that it’s such a trial process to find a medicine that actually works/does what it’s formulated to do, but such is apparently the world of mental health medicine. :S
The Wellbutrin works for me. No, it’s not a BPD treatment in and of itself (nothing is, as of yet), but it’s worked for my depression and I really believe that when you’re under the weight of full-blown, brain-chemistry-skewing depression, it’s hard for anything else to get through at all. So feeling that lessen a bit was crucial to being able to approach the BPD problem as a whole. Taking my average/normal mood from “Can’t possibly get out of bed” up to “This sucks and I hate everything but I can function” was essential. Wellbutrin is not associated with weight gain and I haven’t noticed any side effects, though of course that can vary depending on the person.
Last week, I saw my family doctor and related the events of Christmas (i.e. horrendous emotional blowouts with friends/family, and lots of suicidal impulses). So he added Abilify (an anti-psychotic, often used in higher doses for bi-polar and schizophrenia) to my regimen. So now I take 300mg Wellbutrin and 2mg Abilify every day. Combined, they are supposed to even out mood swings and bring my overall energy levels up. We’ll see how that works in the long run – so far the Abilify makes me VERY drowsy, but it’s early days yet so perhaps that will go away.
Finally, however, I think the most important use for medication I have found in my BPD is my “worst case scenario” stash. I now have an emergency stash of fairly low-dose lorazepam (i.e. Ativan). I feel kind of disappointed in myself when I admit that, but there you go. It got to a point where I really could not trust myself to do the right thing (or the remotely healthy thing) when I was at my worst.
Rather than wait for that to happen and end up in the hospital or a holding cell or some similarly terrible/dramatic situation that I knew would only make things worse for me, I asked my doctor to prescribe a very small number of tranquilizers/anti-anxiety-type pills that I could have on hand in case things got totally out of control. But not enough that I could (if I went full-on BPD nuts) take them to “make a point” to myself or others. Just enough that if I really couldn’t deal or find a way to calm down, I could take something to lower the intensity a bit and/or sleep some of it off.
It is not an exaggeration to say those emergency Ativan probably saved my life over the Christmas holidays.
Anyone else care to share their thoughts/experiences with meds? Since BPD is, as I said, technically without any specific medical treatment, I’m curious to know what others have tried.
Cat xxxx
Half of a Soul - Life with BPD 
I’ve been considering going to therapy and getting on medication. I’ve been in one of those dangerous places recently, and I really want to find treatments that are effective so I can hopefully prevent another relapse. Unfortunately, mental health care is… finicky to say the least. I’d like to maybe do a short round of CBT or related therapies and try anti-anxiety medication. Something to build up my coping skills. There are one or two reputable psychiatrists in town, but I’m scared of actually getting diagnosed. Mostly because I could get denied coverage, be expelled from my insurance, face stigma etc. Hopefully that won’t happen. Until then, if it even happens, I’ll just keep up the self care.
I hope you find some good CBT and medication, heatherplant. I must say that if a psychiatrist is a good one (and I realize that’s a massive IF), they will care far less about the diagnosis than about your personal symptoms/issues, and will understand your reluctance to be labeled. My current therapist won’t even use the term BPD or identify her patients with it because she believes it just takes attention away from the individual, unique problems into the useless realm of “statistics” and “norms” – which don’t seem to ever help anyone much. I mostly agree with her, but must admit that I have found it helpful to identify as borderline since a lot of otherwise inexplicable behaviour suddenly makes sense to me… xxxx
I can’t imagine any drug that could help with BPD, unless it made us totally void of emotions, like a chemically induced lobotomy!. I take antidepressant and mood stabilisers for my depression. I started them 13 years ago through sheer desperation rather than an informed choice. For the first time in all those years, I am currently on a very low dose of AD’s and quite a high dose of stabilisers (Quetiapine). I often wonder why I bother, especially of late when my mood has been so low. I suppose (as you said) there is a difference between being able to get out of bed or thinking life sucks. Unfortunately, there is always a down side and my own seems to be weight gain, memory loss and perhaps a lack of creativity with writing.
I agree, Cat, it’s unlikely any drug could specifically “treat” BPD. But in terms of mood stabilisers, I would imagine they could help – or maybe I’m just being hopeful since I’m now supposedly on one! My inability to control my emotional (over)reactions is probably my biggest obstacle right now so I hope something can bring them down to “I’m furious” instead of “I’m smashing things,” and “I’m so depressed” instead of “I’m checking out.” I remain very wary of the random side effects that all these drugs can have, but at the end of the day, I feel like any improvement is worth the effort of trying, and after all, I can always stop/change medications. It’s definitely a personal choice though and I could easily see the argument against them too. I hope you find a combination (or lack thereof?) that works for you! xxxx