Is There Medication for Borderline Personality Disorder?

Borderline personality disorder (BPD) is a complex mental health condition marked by emotional instability, intense relationships, fear of abandonment and impulsive behavior. While therapy is the cornerstone of borderline personality disorder treatments, medication can provide meaningful support, especially for mood swings, anxiety and co-occurring conditions.

If you’re navigating BPD or supporting someone who is, understanding the role of medication can help clarify what’s possible and what to expect.

What Is Borderline Personality Disorder?

BPD is a mental health disorder that affects the way a person thinks about themselves and others. It often involves:

• Unstable self-image
• Intense and rapidly shifting emotions
• Difficulty maintaining relationships
• Impulsive behaviors
• Chronic fear of abandonment
• Episodes of anger, anxiety or despair

According to the National Institute of Mental Health, an estimated 0.7%-2.7% of adults in the United States experience BPD.

Borderline Personality Disorder Treatments: An Overview

Therapy is the first-line treatment for BPD. The most evidence-based approach is dialectical behavior therapy (DBT), which helps individuals build emotional regulation, distress tolerance, mindfulness and interpersonal skills.

Other effective therapeutic options include:

• Cognitive behavioral therapy (CBT)
• Mentalization-based therapy (MBT)
• Schema therapy
• Transference-focused psychotherapy (TFP)

These therapies help address the root causes of emotional dysregulation and relationship instability while building long-term coping tools.

Is There BPD Medication?

There’s no FDA-approved BPD medication, but psychiatrists often prescribe medications to target specific symptoms. These medications aren’t cures but can make engaging in therapy and managing daily life easier. Here are common categories of medication for borderline personality disorder and what they aim to treat.

1. Mood Stabilizers

These medications are sometimes used to reduce mood swings, impulsivity and aggression.

Examples include:

• • Lamotrigine (Lamictal)
  • Valproate (Depakote)
  • Topiramate (Topamax)

Mood stabilizers can be helpful for individuals with intense emotional reactivity or co-occurring bipolar traits.

2. Antidepressants

While BPD isn’t a depressive disorder, doctors may prescribe antidepressants for people who also struggle with depression or anxiety.

SSRIs are the most commonly used antidepressants in this context and include:

• • Sertraline (Zoloft)
  • Fluoxetine (Prozac)
  • Escitalopram (Lexapro)

They can help reduce chronic sadness, anxiety and irritability, but results are mixed when used for BPD without accompanying therapeutic treatment.

3. Antipsychotics

Atypical antipsychotics can help with impulsivity, anger and distorted thinking, especially in cases with psychosis-like symptoms or severe emotional instability.

Examples include:

• • Aripiprazole (Abilify)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)

These medications are typically used at low doses and under close supervision.

4. Antianxiety Medications

People with BPD often struggle with intense anxiety. However, benzodiazepines (like Xanax or Ativan) are generally avoided due to the risk of dependence and increased impulsivity.

Buspirone is a nonaddictive option that may be considered. Some antipsychotics or SSRIs may also help with anxiety symptoms.

What Medication Can and Can’t Do

What medication can do:

• Help stabilize mood and reduce emotional extremes
• Lower anxiety and improve sleep
• Lessen the intensity of impulsive behavior
• Support engagement in therapy by easing distress

What medication can’t do:

• Cure BPD or fully prevent emotional dysregulation
• Replace the need for therapy
• Instantly resolve core fears around abandonment, identity or self-worth

Medication is most helpful as part of a larger treatment plan that includes consistent therapy, support and self-care.

Risks and Considerations

Your health care provider will carefully prescribe and medications for BPD and monitor you closely. People with BPD may be more sensitive to side effects or may respond unpredictably to certain drugs. It’s also important to avoid medications with high abuse potential or sedating properties unless absolutely necessary.

You and your provider should discuss:

• The specific symptoms you want to target
• Any past experiences with medication
• Potential side effects and drug interactions
• A plan for regular follow-up and dose adjustments

When to Consider Medication for BPD

Medication may be worth exploring if:

• Intense emotions are interfering with daily functioning.
• Anxiety, depression or impulsivity make therapy difficult to access.
• There are co-occurring conditions like PTSD or bipolar disorder.
• You’ve tried therapy alone and need additional support.

If you’re unsure, talking to a psychiatrist with experience in personality disorders can help clarify whether medication might be beneficial for your specific situation.

The Mental Health Hotline can help you find a provider who specializes in BPD, free and confidentially.

Frequently Asked Questions