Best Medication for Borderline Personality Disorder: What You Need to Know
Author:
Blossom Editorial
Jan 9, 2026
There are currently no FDA-approved medications specifically designed to treat borderline personality disorder (BPD). However, psychiatrists commonly prescribe certain medications to manage specific BPD symptoms such as mood instability, impulsive aggression, anxiety, and depression, typically as an adjunct to psychotherapy rather than as a primary treatment.
Understanding how medications fit into comprehensive BPD treatment, which symptoms they target, and the importance of therapy-first approaches can help you make informed decisions about your mental health care.
Key Takeaways
No medications are FDA-approved specifically for borderline personality disorder, though up to 96% of people with BPD receive at least one psychiatric medication to help manage specific symptoms like mood swings, impulsivity, or depression.
Psychotherapy, particularly dialectical behavior therapy (DBT), is the first-line treatment for BPD and is more effective than medication alone, with research showing that people who receive BPD-specific therapy typically need fewer medications over time.
When medications are used for BPD, they work best alongside therapy, not as a replacement. They can help control short-term symptoms while therapy helps build long-term coping skills.
Understanding Borderline Personality Disorder
Borderline personality disorder is a complex mental health condition affecting approximately 0.7% to 2.7% of adults in the United States. The condition is characterized by:
Intense and rapidly changing emotions that are difficult to regulate
Unstable relationships that oscillate between idealization and devaluation
Impulsive behaviors that can be self-destructive
Recurring thoughts of self-harm or suicide
Chronic feelings of emptiness
Intense fear of abandonment, whether real or perceived
Unstable sense of self and identity
These core symptoms create significant challenges in daily functioning, relationships, and overall quality of life. While BPD is serious and can be debilitating, it's also highly treatable with appropriate interventions.
Why There Are No FDA-Approved BPD Medications
The absence of FDA-approved medications for BPD reflects several important factors about the nature of the condition and how it responds to treatment.
BPD as a Developmental Disorder
Unlike conditions such as depression or schizophrenia that have clearer neurochemical mechanisms, BPD is conceptualized as a disorder of personality development and emotional regulation. The condition affects how a person sees themselves and others, leading to problems with identity, relationships, empathy, and motivation.
These core features don't respond well to medication alone because they involve learned patterns of thinking, feeling, and relating to others that developed over time. Changing these patterns requires active skill-building through therapy rather relying on chemical intervention.
Research Challenges
Clinical trials for BPD medications face unique obstacles. Many studies have excluded patients with the most severe symptoms, such as active suicidality or recent suicide attempts, limiting how well findings apply to real-world populations.
BPD frequently occurs alongside other conditions like depression, anxiety, or substance use disorders, making it difficult to isolate which symptoms respond to which medications. Because BPD affects people in different ways, no single medication works well for everyone. Natural symptom improvement over time can make it hard to determine whether changes result from medication or the normal course of the disorder.
When Medications May Be Helpful for BPD
While psychotherapy remains the cornerstone of treatment, medications can play a supportive role in managing specific symptom clusters when they're severe enough to interfere with daily functioning or engagement in therapy.
Symptom-targeted Approach
The updated American Psychiatric Association practice guidelines recommend a symptom-targeted approach rather than treating BPD as a whole. Medications may be considered for:
Affective dysregulation, which includes intense, rapidly shifting emotions and mood instability
Impulsive-behavioral dyscontrol, which includes impulsive aggression, self-harm, or risk-taking behaviors
Cognitive-perceptual symptoms, which include brief stress-related paranoid thinking or dissociative experiences
This approach recognizes that different medications affect different symptoms, and treatment should be tailored to each person's specific presentation.
Medication as Adjunct to Therapy
Clinical guidelines emphasize that medication should supplement rather than replace psychotherapy. Research shows that people who receive BPD-specific psychotherapy usually require fewer medications, which helps reduce polypharmacy and its associated risks.
The role of medication is typically to:
Reduce symptom intensity enough to allow engagement in therapy
Manage comorbid conditions like major depressive disorder or anxiety that complicate treatment
Provide short-term crisis stabilization during acute periods
Address specific symptoms that haven't responded adequately to psychotherapy alone
Medication Classes Used for BPD Symptoms
Although no drugs are FDA-approved for BPD, several medication classes are commonly prescribed off-label to target specific symptoms.
Antidepressants
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medications for people with BPD, particularly for managing depressive symptoms and anxiety.
Common SSRIs used:
Fluoxetine (Prozac)
Sertraline (Zoloft)
Escitalopram (Lexapro)
Paroxetine (Paxil)
Research on SSRIs’ effectiveness for BPD shows mixed results. A systematic review found that SSRIs can help reduce impulsivity and aggression but have less impressive effects on depression in BPD compared to other antidepressants. At higher dosages, SSRIs appear to reduce impulsivity and aggression more effectively.
Important considerations for antidepressants in BPD:
They work better for comorbid depression or anxiety than for core BPD features.
The micro-depressions common in BPD may not respond the same way as major depressive disorder.
People with BPD may need different dosing strategies than those used for depression alone.
Antidepressants should be used cautiously alongside psychotherapy rather than as a standalone treatment.
Mood Stabilizers and Anticonvulsants
These medications, typically used for bipolar disorder or seizures, have shown some effectiveness for emotional dysregulation and impulsive behaviors in BPD.
Commonly prescribed options:
Lamotrigine (Lamictal)
Valproate (Depakote)
Topiramate (Topamax)
Research indicates that mood stabilizers and anticonvulsants can have moderate effects on depression and may improve aggression and impulsivity in some individuals with BPD. However, the evidence is not as strong as for their use in bipolar disorder.
Antipsychotic Medications
Low-dose atypical antipsychotics are sometimes prescribed for specific BPD symptoms, despite the name suggesting they're only for psychotic disorders.
Second-generation antipsychotics used:
Quetiapine (Seroquel)
Aripiprazole (Abilify)
Olanzapine (Zyprexa)
Antipsychotics have been used to help manage:
Transient stress-related paranoid thoughts or dissociative symptoms
Impulsive aggression that hasn't responded to other treatments
Severe emotional dysregulation
Research shows that second-generation antipsychotics can have effects on aggression, though results for other symptoms are mixed. The evidence for using antipsychotics in BPD is generally stronger than for antidepressants, particularly for impulsive-behavioral symptoms.
Important safety considerations include potential side effects like weight gain, metabolic changes, and movement disorders, even at low doses.
Anti-anxiety Medications
Benzodiazepines like lorazepam (Ativan) and clonazepam (Klonopin) are generally not recommended for people with BPD due to specific risks in this population.
Why benzodiazepines are problematic:
They reduce inhibitions and can increase impulsivity rather than decrease it.
The risk of dependence and substance abuse is higher in BPD.
They may worsen suicidal thinking in some individuals.
Short-term relief can interfere with learning distress tolerance skills in therapy.
Current clinical guidelines strongly discourage regular benzodiazepine use for BPD. Alternative anti-anxiety medications like buspirone may be considered if needed, though evidence for effectiveness specifically in BPD is limited.
Emerging and Alternative Treatments
Some newer or less conventional approaches have shown promise in studies:
Omega-3 fatty acid supplementation: Studies suggest omega-3s may improve impulsivity and mood dysregulation, particularly when combined with other treatments.
Opiate receptor antagonists: Research indicates these medications may help reduce some self-harm behaviors.
Memantine: It is a medication typically used in dementia. One study showed improvement in BPD symptoms when added to standard treatment.
Oxytocin: This neuropeptide has been shown to lessen threat sensitivity and may improve interpersonal dysfunction, though it's still investigational.
These approaches require more research before becoming standard practice, but they represent potentially valuable additions to the treatment toolkit.
Getting the Right Help for BPD
If symptoms of BPD are affecting your mood, relationships, or daily life, professional support can help you better understand your experiences and build healthier ways of coping. Virtual mental health care makes it easier than ever to connect with experienced providers from the comfort of home.
At Blossom Health, we connect you with board-certified psychiatrists who have experience treating BPD and related challenges. Our providers work with you to understand your symptoms, explore evidence-based treatment options, and support long-term emotional stability. Visit Blossom Health to schedule your first appointment and take the first step toward greater balance and well-being.
Medical Disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. If you are experiencing a mental health crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988.
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