Hi @outlander,
I think I have a similar perspective to @Neelix. I have been mostly medication free for the entire twenty years since I was originally diagnosed with BPD. This is mainly because medication is known to be pretty ineffective for treating BPD per se (although very low doses of a particular antipsychotic can have a mood stabilizing effect). However, I have at various times been on different medications to help with anxiety and depression. One antidepressant I was on is so notorious for increasing appetite, that in veterinary medicine this is what it is used for - to stimulate appetite in sick cats who don't want to eat. I found that this particular antidepressant would really help me mood-wise for a few weeks and then become ineffective. I refused to increase the dose due to the hunger issues. Instead, I would go on and off it every few weeks. I did this for about ten years and found it very helpful.
In the past few months with all my dramas of therapist shopping, I have experienced a deeper depression than ever before. Consequently, I have been on a different antidepressant for a couple of months and I am finding it is having an awesome effect on my energy levels, without impacting on my appetite at all. I tried this same medication several years ago and it had the awful side effect of increasing SI. However, that hasn't happened at all this time.
So...I guess what I'm saying is that there are options out there. Our brains are so amazingly complex, that what works for one person won't work for another. Also, as someone else mentioned, some of the decisions around medication come down to what you personally are willing to put up with. For me, the constant hunger (and subsequent weight gain) from the antidepressant was negatively impacting on my mood and therefore it made no sense to me to keep taking it. However, in choosing not to take medication, one must accept the consequences of that. So yeah, totally a personal choice. Your body, your life, your choice. 