Although it is clear from research studies that some patients with borderline personality disorder improve following pharmacological treatment, their response to drugs may be unpredictable. Neuroleptics and carbamazepine may reduce impulsivity in some patients, but other patients may become melancholically depressed. Alprazolam and tricyclic antidepressants may improve mood, but some patients may also become disinhibited, suicidal, and violent. Therefore, any medication trial should be conducted with careful attention to paradoxical effects.In our work, medications are a very valuable tool. They can often help patients attain a much greater level of functioning, diminish family crises, enable therapy to progress more smoothly, and may reduce the need for hospitalization or emergency interventions.