Do SSRIs Increase Self-Harm in People with Borderline Personality Disorder?

SSRI self-harm BPDBorderline Personality Disorder (BPD) is strongly associated with self-harming behavior. In fact, 60 percent to 80 percent of people with BPD engage in non-suicidal self injury (NSSI), according to Michael McCloskey, PhD, of Temple University.

Additionally, 60 percent to 75 percent of people with Borderline Personality Disorder attempt suicide. Ten percent of people with BPD complete suicide.

With BPD, self-harmful behavior threatens more than the quality of life — it threatens life itself. Finding treatment is of the utmost importance when it comes to treating self-harm in those with BPD. More to the point, finding the right treatment for Borderline Personality Disorder.

BPD often co-occurs with severe depression and anxiety disorder. The most commonly prescribed treatments for those disorders are selective serotonin reuptake inhibitors (SSRIs).

But what if the very drug prescribed for depression and anxiety is found to actually increase the dangerous self-harmful behaviors so often found in people with BPD?

In a talk for the National Education Alliance on Borderline Personality Disorder (NEA.BPD), McCloskey discussed a study he conducted on the relationship between BPD and SSRIs, and whether or not the use of SSRIs increases this self-harming behavior.

SSRIs and Self-Harmful Behaviors

First developed in the 1970s, selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants that work by increasing the amount of the neurotransmitter serotonin. SSRIs have generated controversy, as reports have shown increased self-harming behavior during the first month of treatment, especially in younger patients. In fact, the U.S. Food and Drug Administration (FDA) requires a warning on SSRIs indicating that use could lead to suicidality among individuals under 25.

McCloskey’s study was to “prospectively assess the impact of early SSRI treatment on self-harm among 200 subjects with BPD and depressive symptoms, aged 18 to 40.” The study would randomize participants to SSRI (escitalopram) or placebo for eight weeks. The subjects would self-report instances of suicidal ideation, suicide attempts, NSSI, depression, and self-harm. Subjects were called four times a day for reports.

The hypothesis was that those randomized to use SSRIs would report less self-harm ideation and behavior compared to those given the placebo. The team also hypothesized that age would moderate the relationship between SSRI and self-harm, and that those with symptoms of affective dysregulation (such as impulsivity and aggression, both symptoms associated with BPD) will also moderate the relationship.

Based on results of his study, McCloskey summarizes that research is mixed on the effects of SSRIs and self-harming behavior and ideation. He posits that, if there is a link between the prescription of SSRIs and NSSI, it is more likely to occur within the first few weeks of treatment and in younger patients or patients who have greater affective dysregulation.

McCloskey believes that more research on a larger population can provide a more accurate look at if SSRIs increase self-harmful behaviors in people with Borderline Personality Disorder.

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