Rates of Psychotropic Medication Use Reported by Borderline Patients and Axis II Comparison Subjects Over 16 Years of Prospective Follow-Up

Abstract

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 eight contiguous two-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 seven of the ten more specific types of medication studied (i.e., all but tricyclic antidepressants, monoamine oxidase inhibitor antidepressants [MAOIs], and atypical antipsychotics). The rates over time of taking antipsychotics and mood stabilizers were stable, while there was a significant decline in the rates of antidepressants and anxiolytics from baseline to eight-year follow-up (but not from eight 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, while 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.

Fluidity of the Subsyndromal Phenomenology of Borderline Personality Disorder Over 16 Years of Prospective Follow-Up

“…It may be that these dysphoric affects are in this stubborn group of symptoms because they represent inadequately treated mood and/or anxiety disorders, which are common co-occurring disorders among borderline patients (18). However, a high proportion of borderline patients used psychosocial treatments (19) and psychotropic medications (20) over time. It may also be that these symptoms represent a reasonable response to the limited lives led by a substantial percentage of borderline patients—lives marked by social isolation and serious vocational impairment (21).…”

“…Another limitation is that about 90% of those in both patient groups were in individual therapy and taking psychotropic medications at baseline and about 70% were participating in each of these outpatient modalities during each follow-up period (19). More specifically, 65% of borderline patients were in individual therapy and 71% were taking standing medications at 16-year follow-up, with 58% taking antidepressants, 26% taking anxiolytics, 28% taking antipsychotics, and 29% taking mood stabilizers (20). Thus, it is difficult to know if these results would generalize to a less disturbed group of patients.…”

Amazon Mechanical Turk as a platform for borderline personality disorder research

“…Zanarini and colleagues (Zanarini, Frankenburg, Reich, Harned, & Fitzmaurice, 2015) investigated psychiatric medication use in BPD compared to other personality disorders. They found that people with BPD took more antidepressants (1.3 times more), antipsychotics (2.6 times more) and mood stabilizers (3 times more) than did comparison subjects.…”

An update on pharmacotherapy for personality disorders

“…In addition, it has been observed that low doses of secondgeneration antipsychotics could improve cognitive-perceptual symptoms [4]. Antidepressants, anxiolytics, antipsychotics, and mood stabilizers are used by a significantly higher percentage of borderline patients than other people with personality disorders [5]. This is not surprising as it is recognized that borderline psychopathology is more severe than that of other types of personality disorders.…”