Anything to Stop the Pain - BPD and Non-BPs

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.

Bon Dobbs :: May.29.2008 :: Biology, Medication, Borderline Personality Disorder :: No Comments »

One of the physical aspects of BPD is problems with sleep. People with BPD are likely to have trouble going to sleep and trouble getting up in the morning. One of the reasons is the “ruminating” aspect of BPD. Another seems to be that their brain chemistry is configured in such a way to utilize serotonin ineffectively. Many people with BPD will require sleep medications and sometimes will take these medications in large doses. This inability to sleep and awake punctually can also contribute to getting fired from jobs. If a BP can’t get up on time and make it on time to a job, they might get fired. Losing a job can contribute to shame. Jobs that have a lot of “down time” (time in which nothing is going on, like lulls in retail positions) can cause more ruminating and may lead to conflict between someone with BPD and their co-workers or superiors.

I found another reference to sleep issues on the Internet. According to this site, people with BPD have “significant abnormalities in REM sleep with more rapid onset and more intense REM sleep.” I’ve noticed that my wife has trouble falling asleep with major insomnia and has trouble getting up in the morning. If your BP has a job that he/she has to be at early in the morning, it might be time to find a new job.

Here is a reference I found on Paul J. Markovitz M.D., Ph.D.’s CV:

Markovitz, PJ, Comorbidity of migraines, PMS, IBS, fibromyalgia, neurodermatitis, and sleep apnea in borderline personality disorder: a possible serotonin link. Presented at the World Health Organization meeting on Personality Disorders, Cambridge, MA, September 1993.

Bon Dobbs :: May.29.2008 :: Biology, Medication, Borderline Personality Disorder :: No Comments »

Hi all. I stumbled across this petition about Effexor… thought it might apply to some of your BP’s if they have ever taken the stuff. I used to call the stuff Side-Effexor because of all the negative side effects that stuff caused. Anyway here’s the link if it applies to you: http://www.petitiononline.com/effexor/

Bon Dobbs :: Mar.25.2008 :: Medication :: 2 Comments »

From the biological unhappiness site:

No medication should be given without proper medical supervision. This is particularly true for the drugs used to treat the borderline disorder. Some medicines make the symptoms of borderline worse, especially amitryptilline (Elavil) and alprazolam (Xanax). Possibly a third of borderlines may suffer from low thyroid (hypothyroidism) - despite a normal ‘TSH’ blood test. They may need to take thyroid medication.

My BP does take xanax and it makes everything MUCH worse. Also, she has thyroid issues which seemed co-incident with her first really BP-like behavior. Still, it is difficult to separate the meds, hormones and behaviorial aspects.

Benzos and BPD

bon :: Oct.07.2006 :: Medication, Borderline Personality Disorder :: No Comments »

From a very good article describing co-existing issues with BPD:

Millon (1996, p. 200) notes that individuals with BPD are characterized by drug-seeking behavior. Individuals with BPD will be particularly vulnerable to the escape offered by drugs and alcohol. Real world interaction triggers multiple interpersonal crises and overwhelming negative affect. Drugs can, ostensibly, offer relief from BPD turmoil and emptiness.

And for me, this one struck home:

Individuals with BPD often use alcohol and other drugs in a chaotic and unpredictable pattern; they may engage in a polydrug pattern involving alcohol and other sedative-hypnotics for self-medication. Clients with BPD often abuse benzodiazepines that have been prescribed for anxiety — which can lead to a relapse to their actual primary drug of choice (Ries, TIP #9, 1994, p. 55).

http://www.toad.net/~arcturus/dd/borderln.htm

bon :: Feb.21.2006 :: Substance Abuse, Medication :: No Comments »