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Mental Disorders

Medication Treatments Continued

Simone Hoermann, Ph.D., Corinne E. Zupanick, Psy.D. & Mark Dombeck, Ph.D.

Here are the classes of medications that are commonly used to treat people with personality disorders:

Neuroleptics: Neuroleptics are sometimes referred to as anti-psychotic drugs. These drugs are usually prescribed to treat perceptual and cognitive problems such as when someone has a hard time distinguishing what is real, from what is not. Examples of these kinds of symptoms include suspiciousness, odd communication, or confusion about reality. Experts note that neuroleptics are not only helpful with these perceptual difficulties, but are also beneficial because they can reduce symptoms of mood disturbances, anxiety, and irritability. Neuroleptics are frequently used for the treatment of Schizotypal and Borderline Personality Disorders.

Selective Serotonin Reuptake Inhibitors (SSRIs) are most often prescribed for both depression and anxiety disorders.  However, since these drugs are helpful in regulating emotional extremes (intense anger, depression, or anxiety) and reducing impulsive and aggressive behaviors, they are also helpful in treating certain personality disorders.  Serotonin is one of several neurotransmitters produced in the brain.  Neurotransmitters may be viewed as chemical messengers that facilitate communication among the neurons in the brain.   SSRIs are believed to relieve the symptoms of depression by blocking (inhibiting) the re-absorption (re-uptake) of serotonin in receptor cells in the brain.  This blocking action means there is more serotonin available. The presence of this additional serotonin has the effect of elevating a person's mood, tempering emotional extremes, and reducing anxiety.  Furthermore, there are several indications that the serotonergic system plays an important role in regulating or controlling impulsive aggression (such as angry outbursts) (Coccaro & Siever, 2005).  These symptoms (emotional dysregulation, impulsivity, and aggression) are commonly associated with Cluster B personality disorders (Anti-social, Narcissistic, Borderline, Histrionic).  Therefore the use of SSRIs in the treatment of these disorders is sensible to consider. The serotonergic system has been studied quite extensively in people with personality disorders and these studies are quite promising (Coccaro & Siever, 2005).

Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) are usually used to treat depression and anxiety disorders.  SNRIs inhibit the reuptake (reabsorption) of both serotonin and norepinephrine. These are two neurotransmitters (chemical messengers) in the brain. By inhibiting the reuptake of neurotransmitters they remain in the synapse longer. This increases the levels of both of these neurotransmitters.  The increased level of serotonin is thought to relieve anxiety and depression, whereas the increased level of norepinephrine is assumed to help people feel less lethargic, and more energetic.

Monoamine Oxidase Inhibitors (MAOIs) are thought to block the processing of three important neurotransmitters in the brain: serotonin, dopamine and norepinephrine. These three neurotransmitters appear to have a significant impact on a person's mood.  MAOIs are used for treatment of depressed mood. However, they interact very severely with some foods and certain medications.  In patients with personality disorders, MAOIs may be prescribed to relieve depressed mood, low energy, over-sleeping, and a sensitivity to interpersonal rejection. For instance, MAOIs have been used to treat social anxiety and rejection sensitivity in people with Avoidant Personality Disorder.  Some experts believe MAOIs are useful for treating problems of hostility and impulsivity in people with Borderline Personality Disorder.

Lithium Carbonate and Anticonvulsant Mood Stabilizers are commonly used for the treatment of Bipolar Disorder. With respect to personality disorders, they may be prescribed to address impulsive dys-regulation, such as aggressive behaviors, angry outbursts, and impulsive binges. These are behaviors commonly associated with Cluster B personality disorders. These drugs have been studied particularly for use with the Borderline and Antisocial Personality Disorders.