Tuesday, October 16, 2012

Borderline Personality Disorder and Xanax

Anti-Anxiety medication are often used to treat the intense anxiety and agitation that come with Borderline Personality Disorder.

So why do I feel the need to single out Xanax?

Because it’s so, so, so commonly prescribed for anxiety, which is a huge contributor with BPD. I’m not a doctor or psychiatrist (obviously) so I would never tell you to take or not to take any medication that you’ve been prescribed, but I think it’s also important to be as aware of all information out there. My Psychiatrist won’t prescribe Xanax to me right now, and I’m starting to see why. When I was taking Xanax I was prescribed it by my general physician who wasn’t aware of my BPD, not my Psychiatrist. It wouldn’t surprise me to learn that general practitioners of medicine aren’t aware of all the intricacies of how some medications can combine with mental health issues.  That’s probably why Psychiatry is its own field, yanno? So be sure to make sure all your doctors are in the loop with what is going on. One may be a brain specialist, the other a body specialist, but it’s all important to consider when treating you as a whole.

Antianxiety Agents and Sedatives

“Anxiety and poor sleep are common symptoms of borderline disorder. In other disorders, the benzodiazepines are most frequently used for these symptoms. These include diazipam (Valium), alprazolam (Xanax), temazepam (Restoril), flurazepam (Dalmane), and triazolam (Halcion). These medications should be used with caution in patients with borderline disorder because of their high addictive potential and a reported capacity to increase impulsive behavior in patients with the disorder.

Some patients with borderline disorder also experience adverse responses, such as impaired perceptions and greater sleep deterioration, to the non-benzodiazepine sedatives. Therefore, if these medications are prescribed for you, be aware of this possible problem. [1]

Two of the main problems I’ve seen repeated in terms of Xanax use and BPD are Decreased Inhibitions and Depressed Mood.

Decreased Inhibitions

“Xanax is a type of medication that works by decreasing abnormal signals within the brain that cause excitement. Use of Xanax can cause you to experience decreased inhibitions, which can lead you to engage in dangerous, unusual risk-taking behavior. You can also experience the absence of fear---even if you are in a dangerous situation---while taking this medication. Such side effects can result in abnormal behavior that may have negative consequences, such as injury or increased debt.”

Depressed Mood

“While taking Xanax, you can become depressed experiencing feelings of abnormally sad, guilt-ridden or worthless. You may also notice that you are no longer interested in participating in your usual activities or that you are more tired than usual. Xanax can also cause patients to experience dangerous thoughts of suicide or self-harm. Contact your doctor immediately if you become depressed or suicidal while receiving treatment with Xanax. [2]

With an increased potential for depressed mood and decreased inhibitions, this can quickly escalate to impulsive and dangerous behavior. Even increase the risk for self-harm and suicidal thoughts.
Even Wikipedia states that particular care should be exercised with the case of people with Borderline personality disorder because it may induce suicidality and dyscontrol. By the way, Dyscontrol (or Episodic Dyscontrol syndrome) is defined as a pattern of abnormal, episodic, and frequently violent and uncontrollable social behavior in the absence of significant provocation. I don’t think I need to tell you that combining something that may lead to uncontrollable social behavior without provocation combined with someone that already has problems with controlling volatile emotions, reactions, and behavior is a very, very bad thing.

I was taking Xanax when I was still living with Evil-Ex and while I was dating Boring-Ex. I think things were so disruptive from when I was dealing with Evil-Ex (which was still while I was dating Boring-Ex) that it was probably necessary for me to have something for the intense, intense anxiety I was dealing with, but who knows if it contributed to my cutting or landing me in the Psych ER. Then again, I never took them very frequently. I’ve always been very aware of the addictive and deleterious nature of these kinds of medications so I’ve always been very wary of taking too much of them.

For occasional, situational use, they may be helpful, because for me they certainly did help calm down my brain and ease my anxiety in those moments when I was about to lose it. But long term, daily, regimented use…. ???? …. I don’t know. That’s not my call. But the dangers of addiction and the horror stories of withdrawal are also not something I would ever want to be faced with.

Other issues reported Hyperactivity, seizures, hallucinating, and jaundice. 

I’m also including a video I recently found. It’s only a couple years old so I’m fairly confident that the information is still relevant. It’s also doesn’t seem judgemental which is nice. The first bit talks about Xanax and its effects with BPD, but then it also moves on to consider other drugs as well.  Below the video you can see some of my notes and the things that caught my attention.


“Daily use of modest dosing of Xanax lead to increased self-mutilation and suicide attempts in Borderline Patients.”

“Xanax, like alcohol, is a feel good drug in the moment but over a longer period of time, like alcohol, it disinhibited them and Borderline people are already disinhibited, so taking a drug that contributes to that and all hell can break loose.”

Occasional, targeted use, that’s probably okay, but chronic use? Not so much.

:: Interesting note:: People with Borderline Personality Disorder of some of those most likely to refuse to take a drug if it has significant side effects.

Avoid Benzos except for occasional use.

On discussion of SSRI’s there are two types of depression:
1. The classic type of Major Depressive Disorder, but also,
2. that Characterological Depression of emptiness and dysphoria that is often reported with BPD. 

SSRI’s may help the major depressive disorder type symptoms but don’t touch the characterological depression. *** This strikes a chord with me. *** Note to self to look into this further, b/c currently I feel like my major depression is practically non-existent, but I still have that feeling of emptiness.

Medications may not “cure” Borderline Personality Disorder, but they can target specific symptoms that make focusing on psychotherapy easier and functioning in day to day life, better. They may not fix it completely, but they may help raise the standard of day to day living so that we can get the rest of the way on our own.

This is essentially what I’ve found with the SNRI I’m on. My primary focus was helping my anxiety and depression

There was one last note on “Experimental “”Drug”” Study” that I thought was worth mentioning:  
Omega-3 fatty acids. A regular daily dose over an 8 week period of time showed a significant difference in reducing aggression and depression… with no side effects. I mention this, b/c it’s a good recommendation for pretty much everyone in terms of general health and heart care. Even I try to make sure I take my Omega vitamins (as I’m strict vegetarian and need the supplemental support).

So there are some things to think about. 


  1. Hi Haven. This is very interesting. I use Xanax for stress and anxiety, but I don't have BPD (in case you're wondering, I read your blog largely because I became fascinated by BPD following a past relationship with a BPD person whom I loved very much and lost). I love the light feeling Xanax gives me, as if all my problems and issues are away down the wrong end of a telescope (it's kind of like alcohol without the downside; I can take it at work and keep working). Unfortunately (or fortunately), if I take Xanax when I'm already feeling OK, it has no effect (doesn't make me high). So I only take it when I have an anxiety attack. I know a lot of prople use benzos recreationally, but it doesn't work for me.

  2. Another great post!

    Do you notice if your sleep patterns are different when you're in a relationship versus when you are single? Are they more stable and less erratic when you are going through periods where you feel more comfortable and connected with a significant other?

    Just wondering if you've noticed any correlations.

  3. I think you should select some posts/topics, talk to an editor, and write a book. One that includes the images you use to supplement your written word. I think it would be incredible.

  4. Thank you for this post. I love your blog and am so appreciative that someone is showing the world that Borderlines can be aware, intelligent and dedicated to getting better. I wanted to share my experience as a Borderline with comorbid OCPD and how benzodiazepines have created mayhem in my life.

    I have been prescribed benzos "as needed" since I was 14. The past 20 years they were the only medications that seemed to help or that I could tolerate. They have helped me countless times. They seem innocuous and without side effects. My family and friends are always telling me to "take a Xanax".

    Recently a new psychiatrist decided I should take Klonopin 2x/day everyday. Klonopin is 20 times stronger than Valium and longer lasting than Xanax. He then added another benzo, Ativan. I started getting very sick, turns out it was withdrawal from the gaps between very high doses of benzos. Symptoms are nausea, vertigo, intolerance to light and sound, body aches, paranoia, hallucinations and seizures.

    I am now stabilized, keeping a steady dose in my system, but having tremendous trouble decreasing and getting off the daily Klonopin. The withdrawal is so problematic that my doctors won't help me reduce the dose. It now causes problems instead of helping as my body has adjusted and become tolerant. I can no longer take an extra dose when I am out of control, which was my only effective acute treatment. My mental state has significantly deteriorated since this began a year ago, and after reading this post I have a better understanding of why. To all of my fellow BPD sufferers, please be very careful with all medications and benzos in particular. Never rely on your doctor's recommendation alone and never take benzos daily.

  5. clonazepam 2 mg (1mg bid) long half life hit's gaba-a alpha 2,3,5... hits the raphe everywhere...http://en.wikipedia.org/wiki/Nucleus_pallidus ohhh, rapid eyescanning, amygdala, immune responses that kill the inferior colliculi... basically the amygdala and hippocampus' path to the prefrontal... hence represeed anxiogenic memories in situational variables despite subcortical fear responses ... moderates the central seerotonergic receptor density portion of the brain, lamotrogine 400 mg (na+ blocker, glutamate antagonist, modest serotonergic properties... only at high doses though, n-acetyl cysteine, plus concerta... maybe some agomelatonin.... i could go on for days, and it gets particularly embarassing when discussions with uhhh, clinicians turn into embarassing 15 second white coat authorized lctures followed by a 90 minute description of not only insights unimaginable but novel treatment solutions... then again... i'm not a mechanic, i go bottom up, top down, use phenomenology, fuck, i'm just going to say it, im embarassed to have worked so hard, and would sooner see myself working for the government or a multi-national than in clinical practice, bryzantine hierarchical notions of authority don't stand up when the discrepancy in skill is astronomical, call me an elitist, whatever... i just care about people, and believe that if you're going to work with people's lives, happiness, you should be par excellance... and well, you dont have to read 500 pages to do that, know 7 therapeutic modalities, but knowing your limitations is a start, as is some humble pie, because for someone who doesn't take themselves seriously, most definitely is hf'ing bp, adhd, and anxious avoidant attachment... i'm pretty humble, and puit my money where my mouth is... in other words, 30 seconds to humiliation a minute till it's irreversable, 1.5 till you look like you baught your degree... btw, i have to take clonazepam daily for seizure issues... so yeah, i can vouch for that advice from experince, if you have a choice, please don't... btw, xanax has a short half life, is cognitively dulling, which is bad for the externalizing hyper-vigilant types... but interesting, it also has similar effects on the raphe regions as clonazepam, although much ameliorated.

  6. benzo's are heaven and hell for me as a BPD. They make you feel normal for some time, like you feel the way other people feel and the way other people interact. That is such a relief.

    But: you cannot keep on taken them. I have been taken alprozolam for 10 days(!) yesterday I decided just not to take them and I felt all day like I was drunk, i muttered words instead of clear sentences (well... just like you are drunk). I had to the bathroom every hour. And was very apathic (not depressed) all day. Yesterday at home I decided to take one and I was again 'normal'. This is a phenomenan that cannot be a good sign whatsoverever. Today I decided to get rid of them and as I was standing in front of the toilet to 'dump' them, i decided to take another half because 'it makes me feel normal ans sociable and accepted'. You see, this is pure addiction. Now I managed to get rid of 75% of them, but kept the other 25% to withdraw slowly (I hope 2 or 3 days).

    My only advice: do not use this kind of medication, you probably will end up with much more pain and suffering and that is what I was trying to avoid in the first place.

    What to do then: I find wikipedia's suggestion like thought supperession and others good ideas. Also I do sports (running and stretching) which helps alot when you are able to come to it.

    But benzo's, that is bad shit for sure.

  7. My mind races and I tried suicide BUT valium helps me Just a 10 split in half once a day calms me down .I have to get them from another source as dr try to give anti depressants When on that I do not care what I do I will kill if I feel like it so valium helps Me in every way BUT try to get a fing dr to give it to you. so what will be will be.

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