Although there are no medications approved by the US Food and Drug Administration for the treatment of borderline personality disorder (BPD), polypharmacy is commonly encountered in individuals with BPD. This review summarizes the results of randomized controlled trials on the efficacy of pharmacologic agents in BPD. Pharmacotherapy in BPD is an adjunctive treatment aimed at stabilizing symptoms and behavior in a crisis situation, and it should be avoided whenever possible. Further studies are needed, including large, randomized controlled trials with long-term follow up, to examine the efficacy of psychiatric medications in patients with BPD. ANTIDEPRESSANTS Selective Serotonin Reuptake InhibitorsSalzman et al. 7 described the results of a 13-week, double-blind, placebocontrolled study of the effects of fluoxetine on anger in patients with BPD or BPD traits. Thirteen patients received fluoxetine and nine received placebo. All patients began with a single 20-mg capsule or identical placebo, and doses were titrated up to a maximum of 60 mg/day. The authors found a reduction in anger among the fluoxetine recipients but no reduction in depression.In 2004, the therapeutic effect of fluoxetine added to dialectical behavior therapy (DBT) for the treatment of BPD was examined by Simpson et al. 8 in a 12-week, randomized, doubleblind, placebo-controlled study. Of the 20 patients that completed treatment, 9 were randomly assigned to receive up to 40 mg/day of fluoxetine and 11 were randomly assigned to placebo. The result showed no significant group differences in scores from pretreatment to posttreatment on any measure. Rinne et al.9 conducted a doubleblind, placebo-controlled, randomized trial of fluvoxamine (mean dose 150 mg/day) for 6 weeks followed by a blind half-crossover for 6 weeks and an open follow-up for another 12 weeks in 38 women with BPD. Fluvoxamine improved rapid mood shifts (standardized mean changes [SMD], -0.646) but not impulsivity and aggression.Jariani et al. 10 compared sertraline (50-100 mg/day) to olanzapine (5-10 mg/day) for the treatment of BPD in 120 patients on methadone maintenance therapy for heroin dependence who were also diagnosed as having BPD. The results (evaluation of Symptom Checklist-90 questionnaire before treatment and in the 4th, 8th, and 12th weeks of treatment) indicated that both drugs could generally ameliorate depression, anxiety, hypersensitivity in interpersonal relationships, aggression, obsession, and somatization symptoms in a 12-week treatment. Sertraline was more effective in decreasing symptoms of depression, hypersensitivity in interpersonal relationships, and obsession. Olanzapine was more useful for anxiety, aggression, and paranoia symptoms. There was no difference in decreasing somatization symptoms between both drugs. In regard to selfmutilation, there was a significant difference in the olanzapine group.
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