Medical Treatment of the Borderline Personality Disorder – Biological Unhappiness – Dr. Leland M. Heller

This is the instruction sheet I give to my patients with the Borderline Personality Disorder. It is for information purposes only.

Leland M. Heller, M.D. January 18th, 1998

Medical Treatment of the Borderline Personality Disorder (4069 bytes)

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blubul1a.gif (257 bytes) The Borderline Personality Disorder (BPD) is a devastating neurological illness that causes enormous psychological damage, and usually destroys lives.  The suicide risk is approximately 9%.  The risks of substance abuse, auto and work accidents, divorces, AIDS, child and spousal abuse, and early death are high enough to take this disorder very seriously.  Treatment includes medication, counseling, and “retraining the brain.”  Medication is virtually always needed, and can make a profound difference. blubul1a.gif (257 bytes) SSRI’s: The main symptoms treated by SSRI’s include: mood swings, chronic anger, emptiness, boredom, and depression.  Prozac has been the most thoroughly studied and is very effective.  Alternatives include Paxil and Effexor – choosing these medicines instead of Prozac would be for other illnesses and/or side effects.  Dosage increases usually are effective very quickly, often in one day.  Dosage increases or decreases should not be more often than every week, unless directed to do so by a physician.  Side effects can include shakiness, fatigue, stimulation, insomnia, sleepiness, or nausea. blubul1a.gif (257 bytes) NEUROLEPTICS: Excess production and/or increased sensitivity to the brain chemical “dopamine” seems to be a major cause of rage, anxiety, despair, self-destructive thoughts and impulses, weird body sensations, paranoid thoughts, impulsive behavior and dysphoria (anxiety, rage, depression and despair).  There are many drugs in this class, but Haldol appears to be the best – it works quickly, with minimal side effects and in low doses (generics usually don’t work).  The antihistamine Benadryl will reverse a potential side effect where the muscles go into spasm – notify your physician(s) should this happen.  Long term chronic use, especially in the elderly and/or with high doses, can cause permanent side effects impairing muscle control.  If daily use is needed for a long time, additional medication is likely necessary. blubul1a.gif (257 bytes) Neuroleptics like Haldol should be used whenever anger, stress, paranoia, rage, or self-destructive impulses are present.  They give a BPD patient control over their illness, and can be taken before stressful events to prevent problems.  It is far better to take the medicine when in doubt than suffering the consequences of losing control.  For severe symptoms caused by temporary stress, Risperdal is the strongest and most effective emergency medicine to take as needed, but usually causes profound sleepiness. blubul1a.gif (257 bytes) EPILEPSY DRUGS: The most severe BPD symptoms are likely a form of epilepsy and include “dissociation” (unreality, body parts going numb, deja vu, etc.) and chronic “dysphoria” (anxiety, rage, depression and despair).  When neuroleptics like Haldol are ineffective, epilepsy drugs like Tegretol (carbamazepine), Neurontin, and Depakote can often stop the symptoms in hours.  Depakote (valproic acid) can also control the bipolar disorder.  Blood levels are very important to monitor, as are liver blood tests and blood counts.  Patients who are well educated about the disorder and its treatment can use extra doses when needed, however the risk of side effects (especially grogginess) is increased.

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