Citation

Dimeff LA, McDavid J, Linehan MM. J. Clin. Psychol. Med. Settings 1999; 6(1): 113-138.

Copyright

(Copyright © 1999, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1023/A:1026259431809

PMID

unavailable

Abstract

In the absence of a magic bullet psychotropic medication for treatment of the highly complex and diverse disordered behaviors that comprise BPD, several classes of medications have been applied and experimentally investigated intended to target a narrow range of dysfunctional behavior. Specific classes of medications theorized to target specific areas of dysfunction include: antipsychotics (cognitive dysregulation), antidepressants (affective dysregulation), mood stabilizers and anticonvulsants (behavioral dysregulation, including impulsivity and intense rage), and benzodiazepines (affective dysregulation). While grounded in efficacy studies with other clinical populations and theoretically sound inferences of medication effects with individuals with BPD, pharmacological intent has not predicted outcome. As is apparent from our review of the literature, medications intended to impact a particular dysfunctional domain in individuals with BPD tend to produce nonspecific effects. While helpful in reducing some disordered behaviors, pharmacotherapy effects are frequently paradoxical and occasionally adverse. Additionally, with the exception of SSRIs, many of medications used to treat individuals with BPD can be lethal, further reducing their desirability for patients who are at risk of suicide or accidental overdose. In light of these findings, we recommend conservative and safe use of psychotropics prescribed by individuals with considerable knowledge and experience in treating individuals with BPD. The decision of what, if any, psychotropic medication to prescribe to an individual with BPD should be made on empirical data derived from a population of individuals with BPD (as opposed to other psychiatric disorders) and/or on the basis of what has worked well for a particular individual in the past. We recommend a number of specific strategies to maximize the benefits of pharmacotherapy, including using psychotropics as an adjunct to psychosocial treatments, not prescribing lethal medications to lethal people, consulting with the patient about how best to effectively interact with his or her pharmacotherapist, treating medication noncompliance as a therapy-interfering behavior, and focusing on safety and effectiveness when prescribing these medications.

Language: en