What does the Cochrane review say about medication for BPD?

The 2022 Cochrane review by Stoffers-Winterling and colleagues included 46 randomised trials with 2,769 participants. Compared with placebo, no medication made a difference on any primary outcome (BPD symptom severity, self-harm, suicide-related outcomes, psychosocial functioning), mostly on very low-certainty evidence. The authors concluded that no pharmacological therapy seems effective in specifically treating BPD pathology.

Why am I on medication if it does not treat BPD?

Most often because of a co-occurring condition such as depression, anxiety, ADHD or bipolar disorder, which NICE says may be treated with medication in line with that condition's own guideline. NICE also says people with BPD who are on medication without a diagnosed co-occurring illness should have their treatment reviewed. That review is for you and your prescriber together; NIMH advises talking to your provider before stopping or changing any medication.

Is There Medication for BPD? What NICE and the Cochrane Review Actually Say

Q: Is there medication for BPD?

There is no medicine licensed to treat borderline personality disorder itself, according to the NHS. NICE guideline CG78 says drug treatment should not be used specifically for BPD or for its individual symptoms, such as self-harm or emotional instability. Medication may still be prescribed for a co-occurring condition such as depression, or briefly during a crisis.

Q: Can BPD be treated with mood stabilisers?

Not on current evidence. In the 2022 Cochrane review, mood stabilisers showed little to no effect on BPD symptom severity compared with placebo, though low-certainty evidence suggested they may reduce interpersonal problems. The largest single trial, LABILE, gave lamotrigine or placebo to 276 people for a year and concluded lamotrigine was not a clinically effective or cost-effective treatment for BPD.

Q: Is BPD treated with antipsychotics?

NICE says antipsychotic drugs should not be used for the medium- and long-term treatment of borderline personality disorder. The 2022 Cochrane review found antipsychotics may have little to no effect on BPD symptom severity compared with placebo, on very low-certainty evidence, with low-certainty evidence of a slight reduction in interpersonal problems.

There is no medication for BPD itself: no medicine is licensed to treat it, and NICE guideline CG78 says drug treatment "should not be used specifically for borderline personality disorder". The largest evidence review, a 2022 Cochrane review of 46 randomised trials and 2,769 people, found that compared with placebo, no medication made a difference on any of its primary outcomes. Medication does still have a place: for conditions that come alongside BPD, and for a few days in a crisis.

I have BPD, I am not a clinician, and nothing on this page tells you to start, stop or change anything you take. What it does is tell you exactly what the guideline and the evidence say, in their own words, so you can have a better conversation with whoever prescribes for you.

Is there medication for BPD?

Not for the condition itself. The NHS says: "No medicine is currently licensed to treat BPD." The Cochrane review describes medication use for BPD as "off-label". In the US, the National Institute of Mental Health says the benefits of medication for BPD "are unclear, and it is not a first-line treatment for the disorder".

And yet, as the Cochrane authors put it, among people with BPD in clinical care, "prescription rates of psychotropic medications are high", and people "often receive several psychotropic drugs at a time for sustained periods". If that is you, you are far from alone, and there are usually reasons. Those reasons are below.

What does NICE say about medication for BPD?

NICE guideline CG78 has a whole section on it, 1.3.5, "The role of drug treatment". These are the recommendations, quoted directly:

NICE	What it says
1.3.5.1	"Drug treatment should not be used specifically for borderline personality disorder or for the individual symptoms or behaviour associated with the disorder (for example, repeated self-harm, marked emotional instability, risk-taking behaviour and transient psychotic symptoms)."
1.3.5.2	"Antipsychotic drugs should not be used for the medium- and long-term treatment of borderline personality disorder."
1.3.5.3	"Drug treatment may be considered in the overall treatment of comorbid conditions."
1.3.5.4	"Short-term use of sedative medication may be considered cautiously as part of the overall treatment plan for people with borderline personality disorder in a crisis." It adds that the duration "should be no longer than 1 week".
1.3.5.5	When any drug is considered, you should get written material about it, including the evidence for its effectiveness in BPD and any co-occurring condition, "and potential harm", with a chance to discuss it.
1.3.5.6	People with BPD who have no diagnosed co-occurring mental or physical illness and are being prescribed drugs should have their treatment reviewed, "with the aim of reducing and stopping unnecessary drug treatment".

Notice what 1.3.5.1 covers. It is not only "BPD" in the abstract. It names the very things people most want a pill for: self-harm, emotional instability, risk-taking, and the brief psychotic-type symptoms some of us get under stress.

What did the Cochrane review find?

The 2022 update by Stoffers-Winterling and colleagues is the most thorough look at the evidence there is. It included 46 randomised controlled trials and 2,769 participants, 18 more trials than the previous version in 2010, covering 29 different types of medication.

Its primary outcomes were BPD symptom severity, self-harm, suicide-related outcomes and psychosocial functioning. The headline: "Compared with placebo, no difference in effects were observed on any of the primary outcomes at the end of treatment for any medication."

The authors' conclusion, in their own words: the review "supports the continued understanding that no pharmacological therapy seems effective in specifically treating BPD pathology."

Three honest caveats, all from the review itself:

Most of the evidence is very low certainty. That cuts both ways: it is not proof that nothing could ever help, it is an absence of good evidence that anything does.
Side effects were poorly reported. The authors say reporting on adverse events was "poor and mostly non-standardised", and for antidepressants no adverse event data were identified at all.
Seventeen of the trials were funded or partly funded by the pharmaceutical industry.

They also call for more trials in people with co-occurring conditions such as trauma-related disorders, depression, substance use and eating disorders, and more in men and adolescents. The participants were predominantly female; only one trial was in men.

Can BPD be treated with mood stabilisers?

On current evidence, not as a treatment for BPD itself. In the Cochrane review, compared with placebo:

BPD symptom severity: mood stabilisers "may have little to no effect" (4 trials, 265 participants, very low certainty)
Self-harm: very uncertain, little to no effect (1 trial, 276 participants)
Psychosocial functioning: little to no difference (2 trials, 214 participants, very low certainty)
Interpersonal problems: here is the one positive signal. Low-certainty evidence suggests mood stabilisers "may result in a reduction in this outcome" (4 trials, 300 participants).

There is a UK story behind this. When NICE wrote CG78, it noted "encouraging findings from small-scale studies of mood stabilisers such as topiramate and lamotrigine" and asked for a proper randomised placebo-controlled trial. That trial happened. LABILE, a multicentre UK trial, recruited 276 adults with BPD and gave them up to 400 mg a day of lamotrigine or a placebo. At 52 weeks, BPD symptom scores were almost identical in the two groups, and there was no evidence of differences in secondary outcomes such as depression, self-harm and social functioning. The authors concluded that lamotrigine "is not a clinically effective or cost-effective use of resources" for BPD.

People also search for lithium. I did not find trial evidence on lithium for BPD that I could read and check for this page, so I am not going to tell you anything about it.

Is BPD treated with antipsychotics?

NICE is direct: not for the medium or long term (1.3.5.2). In the Cochrane review, antipsychotics "may have little to no effect" on BPD symptom severity (8 trials, 951 participants, very low certainty). Low-certainty evidence suggests they "may slightly reduce interpersonal problems" (8 trials, 907 participants).

You may read something different on the NHS website, which says mood stabilisers or antipsychotics "are sometimes prescribed to help mood swings, alleviate psychotic symptoms or reduce impulsive behaviour". Both things are true at once: it happens, and the national guideline says it should not be the long-term plan for BPD. If you are prescribed one, 1.3.5.5 means you are entitled to the evidence in writing.

Then why are so many people with BPD on medication?

Usually because BPD rarely arrives alone. NIMH lists depression, post-traumatic stress disorder, bipolar disorder, anxiety disorders, substance use disorders and eating disorders among the conditions people with BPD may be more likely to have, and attention-deficit/hyperactivity disorder among the conditions it often co-occurs with.

NICE's position on those is clear:

1.3.5.3: drug treatment may be considered for co-occurring conditions.
1.3.6.1: before treating one, review both diagnoses, "especially if either diagnosis has been made during a crisis or emergency presentation", and stop treatments that are not working.
1.3.6.2: treat co-occurring depression, PTSD or anxiety "within a well-structured treatment programme for borderline personality disorder".
For any co-occurring condition, follow that condition's own NICE guideline.

So if you have ADHD and BPD, ADHD medication is for the ADHD (how that works for adults is here). If the question is whether it is BPD or bipolar, that matters a great deal for what you are offered, and the differences are here. NIMH describes medication in BPD as sometimes recommended "as an add-on to psychotherapy to treat specific symptoms or co-occurring conditions such as mood swings or depression".

What about medication in a crisis?

This is the one place NICE allows medication for BPD as such, and only briefly. Under 1.3.7.3, a prescriber in a crisis should choose a drug with "a low side-effect profile, low addictive properties, minimum potential for misuse and relative safety in overdose" (it gives sedative antihistamines as an example, noting they are not licensed for this and consent should be recorded), use the minimum effective dose, use a single drug, and agree the target symptoms and how long it is for. Afterwards, the plan should be to stop it, "usually within 1 week".

The NHS describes the same thing more simply: in a small number of cases you may be given a short course of medicine, such as a tranquilliser, "usually prescribed for 7 days".

What does work for BPD?

Psychological therapy. The NHS says treatment for BPD "usually involves some type of psychological therapy", and that DBT is recommended by NICE as the first treatment to try for women with BPD who have a history of self-harming and suicidal behaviour. Mentalisation-based therapy (MBT) is another long-term psychotherapy the NHS lists for BPD.

If you want the route to them: how to get DBT on the NHS. And if the absence of a pill feels like the absence of hope, it is not. The NHS says that over time, many people with BPD "overcome their symptoms and recover". BPD is treatable, and the treatments that work are ones you learn rather than swallow.

What should I ask about my medication?

What is this for? BPD itself, or a co-occurring condition? NICE expects the answer to be the second.
Can I have the evidence in writing? That is 1.3.5.5, including potential harm.
When will it be reviewed? For anything started in a crisis, NICE expects a plan to stop "usually within 1 week", or regular review if it cannot be.
Is a therapy on offer alongside it?

And please do not stop anything on your own because of what you have read here, including this page. NIMH advises discussing concerns with your health care provider "before stopping a medication or making any changes". Take the questions in. Let the prescriber answer them with you.

Sources

National Institute for Health and Care Excellence. Borderline personality disorder: recognition and management (CG78), Recommendations 1.3.5.1 to 1.3.5.6, 1.3.6.1, 1.3.6.2, 1.3.7.3, 1.3.7.4; Recommendations for research, 4: Mood stabilisers. 2009, updated 2024.
Stoffers-Winterling JM, Storebø OJ, Pereira Ribeiro J, et al. Pharmacological interventions for people with borderline personality disorder. Cochrane Database of Systematic Reviews, 2022;11:CD012956. PMID 36375174.
Crawford MJ, Sanatinia R, Barrett B, et al. The clinical effectiveness and cost-effectiveness of lamotrigine in borderline personality disorder: a randomized placebo-controlled trial. American Journal of Psychiatry, 2018;175(8):756-764. PMID 29621901.
NHS. Borderline personality disorder: Treatment. nhs.uk, last reviewed 4 November 2022.
National Institute of Mental Health. Borderline Personality Disorder (publication). nimh.nih.gov.

Read from the published abstracts and guidance on 5 October 2026. If something here is out of date or wrong, tell me.

Nothing here is medical advice, it's lived experience, meant to sit alongside real support, not replace it. If you're struggling, please see the support resources. If you're in crisis in the UK, call Samaritans free on 116 123, or dial 999 in an emergency.