Amitriptyline and BPD

For some reason, I get a lot of searches on this blog about  Amitriptyline and BPD. I posted a note on Amitriptyline and Xanax and their interaction with BPD. I still get a lot of hits on that brief snippet, even though I wrote it back in 2006. I also spelled Amitriptyline with two “l’s” as amitryptilline (Elavil). I’m not sure which is the correct spelling, but I’ll put them both here so people searching can get hits on this post.

Here’s some information on  Amitriptyline studies:

Amitriptyline (Antidepressant Tricyclic)

Soloff PH, George A, Nathan RS, Schulz PM, Perel JM.
1987 Psychopharmacol Bull.23 – Behavioral dyscontrol in borderline patients treated with amitriptyline.
Amitriptyline was associated with a paradoxical behavioral toxicity in patients with BPD, increasing suicidal ideation, paranoid thinking, and assaultiveness significantly more than among placebo nonresponders

Amitriptyline (Antidepressant Tricyclic) / Haloperidol (neuroleptic)
Soloff PH, George A, Nathan S, Schulz PM,… – Western Psychiatric Institute and Clinic, University of Pittsburgh, Pennsylvania.
J Clin Psychopharmacol. 1989 Aug – Amitriptyline versus haloperidol in borderline: final outcomes and predictors of response.
The authors report the final results of a 4-year study of amitriptyline and haloperidol in 90 symptomatic borderline inpatients. Haloperidol produced significant improvement over placebo in global functioning, depression, hostility, schizotypal symptoms, and impulsive behavior.
Significant effects of amitriptyline were generally limited to measures of depression.

Amitriptyline (Antidepressant Tricyclic) / Haloperidol (neuroleptic)
Arch Gen Psychiatry 1986 Jul – Progress in pharmacotherapy of borderline disorders. A double-blind study of amitriptyline, haloperidol, and placebo.
In symptomatic patients with borderline disorder, we conducted a double-blind, placebo-controlled trial of haloperidol and amitriptyline hydrochloride to test the differential efficacy of medication against the affective and schizotypal symptoms that characterize the disorder.
Haloperidol was superior to both amitriptyline and placebo on a composite measure of overall symptom severity, with no difference between amitriptyline and placebo.
Haloperidol produced significant improvement on a broad spectrum of symptom patterns, including depression, anxiety, hostility, paranoid ideation, and psychoticism. In contrast, amitriptyline was minimally effective, with small gains limited to some areas of depressive content.

Here’s more on that abstract about amitryptiline (Elavil):

Paradoxical effects of amitriptyline on borderline patients

PH Soloff, A George, RS Nathan, PM Schulz and JM Perel

A paradoxical increase in suicide threats, paranoid ideation, and demanding and assaultive behavior occurred among 15 borderline inpatients receiving amitriptyline in a double-blind study. This pattern differed significantly from that of 14 nonresponding patients receiving placebo.

As you can see, if dyscontrol and and increase in  “suicide threats, paranoid ideation, and demanding and assaultive behavior” occurs in people with BPD on Amitriptyline – it’s probably best to stay away from it. Of course, I’m not a doctor. Obviously, you should consult one before stopping meds or beginning new ones.