The purpose of this study was to assess the classes and types of psychotropic medication reported by borderline patients and axis II comparison subjects over 16 years of prospective follow-up. Medication use was assessed at baseline using a semistructured interview of proven reliability and validity as well as its follow-up analog at 8 contiguous 2-year follow-up periods. A significantly higher percentage of borderline patients than axis II comparison subjects reported taking an antidepressant, an anxiolytic, an antipsychotic, and a mood stabilizer over time. They also reported more commonly taking 7 of the 10 more specific types of medication studied (ie, all but tricyclic antidepressants, monoamine oxidase inhibitor antidepressants, and atypical antipsychotics). The rates over time of taking antipsychotics and mood stabilizers were stable, whereas there was a significant decline in the rates of antidepressants and anxiolytics from baseline to 8-year follow-up (but not from 8- to 16-year follow-up) reported by those in both study groups. In terms of specific medications, rates of atypical antidepressants and anticonvulsants were the most stable. In contrast, nonbenzodiazepine anxiolytics declined the most steadily over time, whereas rates of atypical antipsychotics increased significantly over the 16 years of prospective follow-up. Taken together, the results of this study suggest that a substantial percentage of borderline patients continue to use the major classes of medication over time. They also suggest that the declining rates of use tend to stabilize less than a decade after index admission.