The Efficacy of Pharmacotherapy for Borderline Personality Disorder: A Review of the Available Randomized Controlled Trials

Abstract

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.

Personality Disorders in Late Life

“…The treatment for PDs is primarily psychotherapy, with pharmacotherapy typically reserved as an adjunct to target specific symptoms (Francois et al, 2015; Rosowsky et al, 2018). A study of expert consensus indicated that personality-changing, adaptation-focused, and supportive-structuring treatment approaches are useful overall in geriatric psychiatry (Rosowsky et al, 2018).…”

Pharmacotherapy of Personality Disorders

“…Recommendations for the treatment of borderline PD by antidepressants are limited by the situation that pharmacotherapeutic trials, mainly with SSRIs, were only carried out in small groups of patients or in non-blinded conditions. This explains why some review papers concluded that there is no clear-cut effect of antidepressants on the score of depression and on the general level of functioning, while small or even moderate effects were observed on anxiety, anger, separation anxiety, chronic dysphoria as well as boredom and emptiness (Hancock-Johnson et al 2017;Francois et al 2015). On the other hand, effects were only slight or moderate on other affective symptoms reported by borderline PD patients.…”

Biting the hand that feeds: current opinion on the interpersonal causes, correlates, and consequences of borderline personality disorder

“…For example, there is a growing literature examining biological factors associated with BPD but the translation to validated medical or psychopharmacological approaches has been slow 103– 105 . To date, there are no medications approved specifically for use in BPD, and intensive psychotherapy (usually lasting 12 months or more) is the treatment of choice for affected individuals 106, 107 . Such interventions are expensive and time intensive and do not reduce all BPD symptoms for all affected individuals.…”