Asenapine in the treatment of borderline personality disorder

Abstract

Many individuals with borderline personality disorder (BPD) receive medical treatment in clinical practice, although to date, there are no drugs specifically available for BPD. The recent Cochrane guideline suggests a benefit from using second-generation antipsychotics such as olanzapine or aripiprazole; nevertheless, side effects limit their use. Asenapine is a novel FDA-approved atypical antipsychotic for schizophrenia and bipolar disorder. However, it has not yet been tested for BPD. The goal of this observational open-label study was to assess the safety, tolerability and efficacy of asenapine in a series of cases of patients with BPD. Twelve individuals with BPD were recruited and treated with asenapine during an 8-week period. Eight individuals completed the study; a significant improvement was observed in the CGI-BPD (P<0.001) and BSL-23 (P<0.048) scales for BPD symptomatology. Besides, there was a significant improvement in the general psychopathology domains (BPRS, P<0.004), whereas no significant differences were observed in depressive symptoms. No serious adverse effects were reported and a significant weight reduction was observed (P=0.002). Asenapine appears to be a safe and effective agent in the treatment of patients with BPD, especially when other alternatives are not tolerated. These preliminary findings should be replicated in a controlled clinical trial.

Efficacy and Tolerability of Asenapine Compared with Olanzapine in Borderline Personality Disorder: An Open-Label Randomized Controlled Trial

“…More specifically, asenapine was found significantly superior to olanzapine in reducing the severity of affective instability. This finding supports the evidence provided by Martin-Blanco and colleagues [33] of a significant effect of asenapine on affect dysregulation in BPD patients.…”

“…This result is substantially in accordance with preliminary evidence provided by Buchanan and colleagues [28], who found only a minimal effect of both asenapine and olanzapine on depressive symptoms in schizophrenic patients. In addition, this lack of positive effect of asenapine on depressive symptoms in BPD has already been demonstrated in an open-label study published by Martin-Blanco and colleagues [33]. These trends are inconsistent with results of other two clinical trials of subjects with bipolar disorder [52], where asenapine was found superior to olanzapine in improving depressive symptoms during manic or mixed episodes.…”

“…Other studies evaluated the efficacy and tolerability of this drug in treating manic or mixed episodes of bipolar disorder, either in monotherapy or in adjunction to lithium or valproate [30][31][32]. Only one open-label study tested the efficacy of asenapine in 12 borderline personality disorder [33], and found that after 8 weeks of treatment with asenapine (5-20 mg/day) it was efficacious, not only against BPD general symptomatology, but more specifically affective instability, impulsivity, and cognitive symptoms.…”

Pharmacotherapy of personality disorders: what we know and what we have to search for

“…Several open-label studies with different new generation antipsychotics, such as clozapine [62][63][64][65], paliperidone [66,67], and asenapine [68] have shown benefits in the treatment of cognitive perceptual symptoms, anger, and impulsivity in BPD patients. Among the new antipsychotics that have been tested in placebo-controlled trials are risperidone, olanzapine, aripiprazole, ziprasidone, and quetiapine.…”

A Single Dose of Asenapine for the Treatment of Bipolar Patients Affected by Withdrawal Syndrome Induced Psychomotor Agitation: A Pilot, Open-Label Study

“…Second generation antipsychotics have been shown to be safe and effective in the treatment of psychomotor agitation in psychotic and non-psychotic patients [2,3]. In recent studies, asenapine, a second generation antipsychotic acting as an antagonist at various dopaminergic (D2, D3 and D4), serotonergic (5HT2A, 5HT2B, 5HT2C, 5HT6 and 5HT7) and alpha adrenergic receptors (α1A and α2), showed to be safe and efficacious in the treatment of psychomotor agitation in psychotic and non-psychotic patients [4,5]. Asenapine was approved in the USA for the treatment of adults affected by schizophrenia and in both USA and Europe for the treatment of adults with manic or mixed episodes associated with bipolar I disorder with or without psychotic symptoms [4,5].…”