Interesting topic...

Two semesters ago I did a presentation on the use of meds with BPD (incidentally my professor fell off his chair while I was talking and I could barely get through the rest of the presentation).

Anyway, the bottom line is that with BPD, if you are going to use meds to stabilize symptoms, then fine-- but BPD is a therapy-recommended d/o. It is about character organization-- something that cannot be worked on with meds.

Mood stabilizers may help take the edge off the fluctuations.

Benzos may help ease the anxiety. (Must be closely monitored with BPD because of the addiction factor). Have also been known to add to impulsive behavior.

AD's may help the depression. Some have been known to increase aggression.

Tri-cyclics are contraindicated with BPD because of the potential of OD-- they are more dangerous than other meds in regards to the OD actually killing the person.

So as you can see, there are pros and cons. Meds need to be closely monitored when treating BPD.

I speak not only as a psych. student, but as someone who is diagnosed with BPD (like the other 75 million people in the last couple of years, lol). I am one of those classic cases in which my past pdocs have tried everything-- they have exhausted the list of SSRIs, almost killed me with the side effects of tricyclics, used antipsychotics to ease the anxiety (not a good idea. not a good one at all), then after all that, decided-- hey... you are bipolar, too.. let's try a mood stabilizer.

I went unmedicated (besides for the benzos) for a long time. It was last summer that my mood swings got really intense, and the depression was interfering with my schooling (had to drop a class). I decided to try meds again to hopefully take the edge off of the mood swings, and stabilize me a bit. The idea was that I was using the meds as a tool; as an adjunct to therapy. I have been on Trileptal for almost a year now, and to be honest, I haven't been doing a great job of always being compliant with it.

I do a great deal of resarch on borderline character organization. Through my research and my therapist, I start to understand how I came to be the way that I am. And we work. And work some more. This part does not include meds.

I have no idea if I have bipolar d/o in addition to all the characterological stuff. In fact, I do not care. The bottom line is, yes, I have the mood swings. What disorder they fit into does not matter to me. My T, an analyst, encourages me to be compliant on the meds. He is not a fan of medication, but says that if he didn't think it was beneficial, of course he would tell me. He would like to see me be compliant on the meds, in hopes that it would allow me to focus even more on therapy. Yes, my moods do get in the way at times. But the meds scare me-- it is right to 'stabilize' my moods? To supress them? How much of 'me" will be gone once the meds work? Doesn't that impede analysis? My T says to trust him-- that he would tell me if he thought that this was the case.

So after several years of not taking meds, and then almost a year on meds, I am still not at the point in which I can tell if they 'work.' It's a big deal to me, taking meds. I don't want to take away a piece of myself. But I don't want to be ill either, to the point in which it interferes with school and work. It's a tough decision to make.