BPD Response To Mood Stabilizers / Atypicals (?)

Does anyone here have experience with trying mood stabilizers or atypical anti-psychotics, for the purpose of trying to regulate moods swings and intense negative emotions? As well as obsessive, paranoid thoughts and such.

My current understanding is that the subjective experiences of bipolar 1 (in the case of lots of mixed state symptoms) and BPD can be very similar, but that a significant key difference is that with BP, the mood swings and emotions come randomly from within, whereas with BPD, the mood swings, changing perceptions, emotional upheavals, etc are reactive to the environment/situation.

However, even though the causes/sources are different, is it true that the underlying brain chemistry would be quite similar, as far as being subjected to intense moods, thoughts and emotions? And if so, that is why I am wondering if a mood stabilizer or atypical could help (alongside therapy over the years).

Most of the articles I read indicate or outright state that people with BPD were born with brains that, before any type of pathological personality stuff ever started/developed, were naturally very emotionally reactive and sensitive. Then what seems to be the case is that the children with this brain type grow up in a very invalidating environment, and then BPD results. I am sure this way over-simplifying it, but that seems to be the gist.

However it seems that multiple children can grow up in the same invalidating environment type, but the ones who will likely develop BPD are the ones with the emotionally sensitive/charged brains.

So in theory would this mean that a stabilizer / atypical could be of great help? Or is there a factor that will make it ineffective, compared to something like BP?

Has anyone tried it in the past, or trying it presently, and willing to share how well it worked (or didn't)?

Based on the articles I've read, it seems like BPD is sometimes misdiagnosed as BP prior to an accurate diagnosis, so I would think it would be common for people with BPD to have experience trying those types of meds, whether or not they worked / how well they worked.

I'm asking because I am willing to do the therapy thing, but at the same time, I really need to try getting back on my feet again. I am currently unemployed, no money, no vehicle, living with my mother. I am 26 years old. I have a ton of catching up to do and am eager to get started. At the same time, I am afraid of getting out there yet again with a job and such, only to have it all fall apart suddenly (yet again) when I go crazy (yet again). But I don't want to just be an unemployed hermit for the next X number of years while going through therapy, either.

So I'm wondering if maybe meds could help me out for now.

My current T is very anti-labeling and prefers to target symptoms one at a time and such, which is fine. But I also am trying to figure out my "label" for myself in order to know the best approach going forward.

I do know that of this list:

1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance, such as a significant and persistent unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, oranxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid thoughts or severe dissociative symptoms

I ding 9/9 for significant periods of time in my life's history, and 5/9 almost constantly / consistently. I even have the stigmatized scars on my arm from my teenage years. =/

Hi CopperMoon

I don't have a full BPD diagnosis, only traits. That said though, I have found mood stabilisers/atypicals to be helpful. Some I've not reacted well to, though they did help to some degree (lamotrigine and valproate were on that list for me), and some I've found really helpful, like olanzpine and quetiapine/seroquel. Meds really do work differently for everyone though.

When they've worked well, I've found it evened out my intense mood swings, and it improved my impulsiveness and rages. It also helped with my mild paranoia and just slowed everything down in general, rather than everything being on fast forward. Meds aren't going to totally "fix" things, but it's made things easier to cope with and it easier to function on a day to day basis- including being able to do the work in therapy- there's no way I could do the work I'm doing in therapy without that little bit of stability the meds give me.

What's your therapist's thoughts on trying out meds to help?

Thanks for the reply, appreciate it. I don't know if I have BP, BPD, both or neither. I know that diagnosing is often kind of a crapshoot, a sort of 'trial by fire' that the mentally ill and/or disordered have to go through in order to eventually get to a good place. But I was hoping that regardless of the situation that medication might be able to help at least in the short term, since therapy seems to often take so long.

My therapist has indicated that she is anti-psychiatry. However she is a psychotherapist who specializes in treating trauma, so I imagine she has some bias because perhaps she has seen several traumatized people try to medicate instead of processing. So I take her opinion with a grain of salt. I have a lot of respect for her in regards to her psycho-therapeutic value, but I know that is not qualified to call shots for a co-morbid case such (for example) BPD + BP + trauma (which is the layered cake I am fairly convinced I have).

You're welcome

CopperMoon wrote:But I was hoping that regardless of the situation that medication might be able to help at least in the short term, since therapy seems to often take so long.

The thing with meds though, is that they're only going to treat some of the symptoms- mood swings, depression, anxiety and paranoia for example. The therapy is still going to be needed to deal with the trauma and the things you've learned as defence mechanisms- learning to manage the things like abandonment issues, splitting, black and white thinking etc. They're things that meds aren't going to work on. Therapy will take a little while and a lot of patience with yourself- you're going to be learning how to undo some pretty destructive behaviours.

I've found the biggest thing with meds is that they give me a little bit of stability so I can cope with the therapy work. Before I was just way too depressed and dysfunctional to be able to do any of it.

I do understand what your therapist is getting at with people using meds rather than processing the trauma- I think this is where I have been in the past with meds- no-one has recognised the impact of the abuse, and so meds would "work" for a while, but then fail again, because the issues underneath were being ignored. That said, I did meet some pretty poor excuses for therapists though.

I'm still trying to figure out the right med combo :/ I have been diagnosed with bpd but also, recently with bipolar NOS (along with other dx's).

I am on abilify (an atypical ap, but you prob know that) and zoloft. I'm not quite sure if they help me, it is hard to tell. I've only been on abilify for 2 weeks and so far I have weird dreams and maybe feel a little different, not better or worse. Zoloft may be making me more paranoid though so idk.

Anyway, i also experienced mixed episodes. I usually a mixed episodes and a steady depressive episode that i experience, but never mania itself. I was at the hospital too recently for suicide and they mentioned possibly putting me on a mood stabilizer (depakote or lamictal probably) but wanted to wait so i have to talk to my psychiatrist about it in a week. Hopefully you figure it out too, i know it is a frustrating venture :/ Ive been in therapy for a while but still have a really hard time utilizing coping skills and meds arent seeming to make a big change.

Hey there! I'm relatively pro-psychiatry when it comes to BPD so I support testing out some meds to see if they help you function any better. Therapy is important, but PwBPD do have brains that are more emotionally reactive for physiological reasons that meds can help with.

You have to understand though that meds work differently for everyone. I started with a mood stablizer, lamictal (lamotrigine), and found that it did little to nothing for me. In fact, at higher doses I'm convinced that it made me more unstable because of how it reacts with birth control, which has been keeping my PMS under control for years. Now, that might not matter as much if you're a dude, but it's worth noting as lamictal is seen as being very benign in terms of side effects, yet gave me hormonal mood swings from hell. It also didn't do anything for me, but has done wonders for a few people on the boards. It just depends on your reaction.

I've avoided anti-psychotics for now because I'm currently able to keep things together, but they're what's up next if I wanted to try a new med. I have a friend from DBT for whom Abilify is working wonders. She's only been on it for a few weeks, but she says it's really helped her feel more stable. As I've mentioned before on the boards, I would use anti-psychotics as last resort meds. Even among atypicals, the side-effects are rough and they can change you. It might be worth a try if you're really struggling, but while I'm pro-meds, I think it's always worth seeing what you can do with therapy and other meds before you go for the heavy duty stuff.

For me, personally, I've been doing pretty well on an SSRI. I'm co-morbid ADHD so it's been killing my motivation a bit, but I'm crossing my fingers that it will work well with the right stimulant. Lexapro has been keeping me calm and collected. I don't get as irritated and I feel like my mood is a lot more stable. It seems to be working for me. That being said, I've only been on it for 4 weeks. However, I think SSRI's for BPD are underutilized. Anxiety and obsessive paranoid thoughts are part of my issues and SSRI's help for both of those. I think much less about my ex and feel like I can handle each day with a little more ease.

But then again, it all depends on your symptoms and you personally. Get a doctor who is willing to have a serious conversation with you about medication options. It's a hard road and the med-go-round can really suck, but I'm hopeful that most people will find a medication that makes life a bit easier for them.

I am on an SSRI and a mood stabilizer, among others. Given that I also have PTSD, the stabilizer has a difficult task. It has to keep me from flipping out, while fighting my BPD tendencies at the same time. As I've been told by my doctors a few times now, meds only help keep the symptoms from becoming overwhelming; with BPD people, the impulsivity is the big problem. The only thing that can help that is therapy, but at least the meds can help give you more of a fighting chance.

That makes sense to me and is essentially what I'm after. I'm not unwilling to do hard work in therapy, but presently it's way too overwhelming. I am either frozen and stuck, or on top of that, when the session is over, I go home and have rather wild and terrible upheavals. These upheavals so far are not serving any purpose of progress. I'm not "processing" anything and then feeling better. Instead I feel increasingly worse and more confused than before, and then when I return to therapy, I am frozen up again, so it doesn't even get talked about in there, really.

It's really confusing for my perceptions, because I notice from my therapy session and online posting histories, that I am either in a state where I feel absolutely nothing and believe that I never do, or I am in a state of extreme turmoil that I have no idea how to regulate. So there are both challenges that seem to alternate - between needing to be able process emotion but not being able to feel it at all, and then needing to be able to regulate emotion when it does happen but feeling totally unable to do so. It's very "all or nothing" I guess.

I tried an SSRI and at first I think it made me rather loose-lipped in therapy, although I was so out of it I can hardly remember the sessions, but then it started having a very bad paradoxical effect (agitation and suicidal ideation went through the roof) and I have since stopped taking it.

Ideally I'd like to find a cocktail that relaxes some part of me enough to allow me to feel emotions on a regular basis, but also relaxes all of me enough that when the emotions do happen, it's not like getting hit by a semi-truck. Not sure if that's wishful thinking or not, but I want to give it a try.

Well I have had bad reactions to most meds I tried. My theory is that it might be because my symptoms are not caused by faulty brain wiring or by chemical imbalances, but just a distorted way of perceiving and thinking of things. SSRIs made me manic and anti anxiety drugs slowed my heart down so much I had to be taken to the ER in an ambulance.

justagirl00 wrote:Well I have had bad reactions to most meds I tried. My theory is that it might be because my symptoms are not caused by faulty brain wiring or by chemical imbalances, but just a distorted way of perceiving and thinking of things.

That's actually not true. BPD has a biological basis. Mood swings and emotional reactivity in particular are caused by physiological differences in BPD brains.

I think this is an important point because the concept that we just have a crazy way of thinking about things puts all the blame on us. Really, it's usually a combination of genetics and early environment. BPD also tends to run alongside bipolar, which both my grandmother and my sister have. It was actually thought for a while that BPD was a weird rapidly cycling form of bipolar but that's been dismissed as a valid theory. However, I do believe that they do come from similar brain issues that are connected to impulsivity and mood instability. The same thing can be said for ADHD, which is also often co-morbid, as exhibited by yours truly.

The more you know, y'all.