Medications for Treatment of Personality Disorders

Overview of psychiatric medications for treating conditions - depression, anxiety, aggressive behavior - stemming from having a personality disorder.

People with personality disorders are often difficult to get along with and many times, they even find it tough to deal with their own feelings and emotions on a day-to-day basis. So it's no surprise that this group also suffers with other psychiatric conditions such as depression and anxiety. Psychiatric medications may help relieve these comorbid conditions, but they can't cure the underlying personality disorder. That job falls to therapy, which is aimed at building new coping mechanisms.

Medications that may be helpful for treating these related disorders include:

• Antidepressants: SSRI antidepressants such as Prozac, Lexapro, Celexa, or SNRI antidepressant Effexor help relieve depression and anxiety in people with personality disorders. Less often, MAOI drugs, such as Nardil and Parnate, may be used.
• Anticonvulsants: These medications may help suppress impulsive and aggressive behavior. They include Carbatrol, Tegretol or Depakote. Topamax , an anticonvulsant, is being researched as an aid in managing impulse-control problems.
• Antipsychotics: People with borderline and schizotypal personality disorders are at risk of losing touch with reality. Antipsychotic medications such as Risperdal and Zyprexa can help improve distorted thinking. Haldol may help for severe behavior problems.
• Other medications: Anti-anxiety medications such as Xanax, Klonopin and mood stabilizers such as lithium are used to relieve symptoms associated with personality disorders.

Research on Using Medications to Treat Personality Disorders

Almost all studies on using medications to treat personality disorders have been with a borderline personality disorder. Antipsychotic and antidepressant drugs are those with the greatest amount of research evidence. There's also evidence that a minority of individuals may be made worse by medication treatment. However, where there is evidence of aggression and impulsivity, and schizotypal and paranoid features within the personality disturbance, antipsychotic drugs, both typical and atypical, may play a role in the treatment of personality disorders. Researchers, though, note this may not be appropriate for the long-term.

Most of the antidepressant research has been done on SSRIs.   The best results, however, have been shown with monoamine oxidase inhibitors (MAOI), drugs which are usually avoided in those who self-harm, as is common in borderline personality disorder. Mood stabilizers such as lithium, carbamazepine (Carbatrol) and sodium valproate (Depakene) have also been tested in small and generally unsatisfactory controlled trials and show some slight evidence of benefit. Benzodiazepine drugs (Xanax) may help cluster C personalities (avoidant, dependent, obsessive-compulsive) but with a high risk of dependence.

Although there is significantly more information available now than there was some years ago, many professionals feel it's insufficient evidence for any firm guidance to be given on drug treatment.

Sources

• American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC.
• American Psychiatric Association pamphlet on Personality Disorders
• Merck Manual Home Edition For Patients and Caregivers, Personality Disorders, 2006.
• EF Coccaro and RJ Kavoussi, Fluoxetine and impulsive aggressive behavior in personality-disordered subjects, Arch Gen Psychiatry 54 (1997), pp. 1081-1088.
• J Reich, R Noyes and W Yates, Alprazolam treatment of avoidant personality traits in social phobic patients, J Clin Psychiatry 50 (1980), pp. 91-95.