Posted by Elizabeth on January 25, 2002, at 0:57:13
In reply to Re: TCA's and BPD » Elizabeth, posted by Chloe on January 23, 2002, at 18:33:04
> Could you explain in what way TCA's can make BPD worse? I had never heard of this.
I should have been more specific. The TCAs are definitely not a treatment of choice for BPD, simply because it's been pretty well established that they don't work very well. There have also been some studies and case reports suggesting that TCAs (amitriptyline in particular) can have "paradoxical" effects in depression associated with BPD, making patients feel worse rather than better. I'm out of town and don't have my books around, but I believe that TCAs can worsen symptoms such as self-destructiveness, paranoia, and hostility. Again, I think this may not apply to clomipramine.
There may be a relationship between BPD symptoms and mixed mania or hypomania in bipolar disorder. Tricyclics are thought to be more likely to trigger or exacerbate dysphoric (mixed) manic states than other ADs, and this may be why they make some borderline patients worse: because dysphoric mania is part of the problem.
Of course, people with BPD are a heterogeneous group, so it's hard to make general statements about them.
-elizabeth
poster:Elizabeth
thread:90799
URL: http://www.dr-bob.org/babble/20020124/msgs/91499.html