A few months ago a member of my Google Support List for Non-BP’s issued me a challenge. I have noticed that many people with BPD abuse prescription drugs, particularly anti-anxiety medication. Mainly the abuse seems to be of benzodiazepines (aka benzos) which include Xanax (generic alprazolam), Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam) and others (although those seem to be the most popular). I listened to a podcast by a psychiatrist who treats borderline patients. He says almost all of them eventually ask for Xanax.
Xanax has to be the absolute worst drug to treat BPD. Why?See the results of these (rather old) studies:
Gardner, D.L. & Cowdry, R.W.
Am. J. Psychiatry. 1985 – Alprazolam-induced dyscontrol in borderline personality disorder.
The short-acting benzodiazepine alprazolam has been associated with precipitating serious dyscontrol in one placebo-controlled crossover study of patients with BPD
The authors suggest that caution be used in prescribing alprazolam to patients with similar histories.
Alprazolam (benzodiazepine) / carbamazepine and trifluoperazine and tranylcypromine.
Cowdry RW, Gardner DL. – Intramural Research Program, National Institute of Mental Health, Bethesda
Arch Gen Psychiatry. 1988 – Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine.
Physicians rated patients as significantly improved relative to placebo while receiving tranylcypromine and carbamazepine. Patients rated themselves as significantly improved relative to placebo only while receiving tranylcypromine. Patients who tolerated a full trial of trifluoperazine showed improvement, those receiving carbamazepine demonstrated a marked decrease in the severity of behavioral dyscontrol, and those receiving alprazolam had an increase in the severity of the episodes of serious dyscontrol
My wife has gotten much better since I started on this quest of learning about BPD and what, as a loved one, I can do about it (and what I can’t). Yet, she still over-medicates on benzos. So, my list member basically issued me a challenge to see if there is anything I can figure out to do to reduce the pill taking. One member of the list locks up his wife’s pills and doles them out when she needs them. I hesitate to follow his example because I don’t want to be in the position of being my wife’s keeper. Plus, in the past when I have held her pills for her (usually at her request), I have been raged at for “hiding” or “stealing” them (neither of which I do).
Here is my question/challenge: Have any of you been able to come up with an effective way to reduce over-medicating on benzos? That question goes out to the people with BPD (if you have found a way yourself) and to the family members (if you have found a workable solution). This area is one where I have made little head-way and would like some help.