Meta-analyses of mood stabilizers, antidepressants and antipsychotics in the treatment of borderline personality disorder: Effectiveness for depression and anger symptoms

University of Ottawa, Ontario, Canada.
Journal of personality disorders (Impact Factor: 3.08). 05/2009; 23(2):156-74. DOI: 10.1521/pedi.2009.23.2.156
Source: PubMed

ABSTRACT The objective of our study was to complete separate meta-analyses of randomized controlled trials of mood stabilizers, antidepressants and antipsychotics to determine whether these medications are efficacious for depression and anger symptoms in borderline personality disorder (BPD). Studies were obtained from OVID Medline, Cochrane Central Register of Controlled Trials, and PsychInfo. References of all original papers and reviews were searched for additional studies. Index terms included: BPD, randomized controlled trials, drug therapy, medication, and treatment. Studies were included if they were randomized doubleblind placebo-controlled trials, published in a peer reviewed journal, had a majority of patients with BPD or included patients with BPD where anger was a target of treatment. Preference was given to studies using outcome measures that were well known, validated, objective, and based on intent-to-treat data. Where available, measures of anger that incorporated verbal and other indirect forms of aggression were utilized. The StatsDirect meta-analysis program was used to calculate an effect size and 95% confidence interval for each study. Mood stabilizers, with the exception of divalproic acid, were found to have a large pooled effect size (-1.75, 95% CI = -2.77 to -0.74) for anger. Divalproic acid and carbamazepine had a moderate effect on depression. Antidepressants had a moderate effect on anger reduction, but a small effect on depression. Antipsychotics had a moderate effect on anger; however aripiprazole had a much larger effect-size than other antipsychotics. Antipsychotics did not have an effect for depression. Sources of variation between studies included length of treatment (5-24 weeks), drop out rates (5% to 65%), proportion of patients in psychotherapy (0- 100%) and with comorbid mood disorders (0-100%). Unfortunately most

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    • "Lithium also has shown some positive effects on patients with personality disorders. In one study, lithium showed efficacy in reducing anger, irritation and self-harming behavior in patients with borderline PD (Mercer et al. 2009). However, there are no studies investigating the anti-suicidal effects of lithium in patients with PD or patients with affective disorders and comorbid PD. "
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    ABSTRACT: Abstract Objective: Patients with both major depression and personality disorders have a high risk of suicidal behaviour. Lithium is meant to have antisuicidal properties in patients with affective disorders. The antisuicidal effect of lithium in patients with affective disorders and comorbid personality disorders has not been investigated yet. Methods: A post-hoc analysis of a subsample of patients with depression and comorbid personality disorder and a recent suicide attempt (n=19) from the prospective, placebo-controlled lithium intervention study (N = 167), was conducted. Results: Three patients in the lithium group (n=8) and two patients in the placebo group (n=11) presented a suicide attempt throughout the course of the study. No differences between the placebo and lithium group related to suicidal behaviour could be detected. Conclusions: On the basis of the small sample size, among patients with comorbid personality disorder, lithium does not seem to have an effect on suicidal behaviour in contrast to patients with affective disorders without comorbid personality disorder.
    International Journal of Psychiatry in Clinical Practice 07/2014; 18(4):1-12. DOI:10.3109/13651501.2014.940052
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    • "Despite the small evidence base, pharmacological treatment is widely used in BPD therapy. According to Mercer et al. (2009), up to 70% of all BPD patients are taking psychotropic medication on a regular basis. All prescriptions given are in fact 'off-label use', because specific pharmacotherapy does not exist; rather, drugs have to be given for different indications, for example, for the treatment of a comorbid depressive disorder. "
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    ABSTRACT: Pharmacotherapy still seems to play a major role in the treatment of patients suffering from borderline personality disorder (BPD). However, little is known about psychiatrists' detailed perspective on indication and significance of medication. A total of 233 psychiatrists in the city of Munich and in Upper Bavaria were asked by questionnaire about their treatment habits in the medical treatment of patients with BPD. One hundred and forty-one psychiatrists answered the questionnaire (60.5%). In total, 94% of BPD patients were treated with psychotropic medication. Psychiatrists predominantly saw an indication to prescribe antidepressants (98%), followed by antipsychotics, mood stabilizers, and benzodiazepines. Citalopram/escitalopram and quetiapine were mentioned most frequently. The results are discussed in conjunction with the international guidelines for the treatment of BPD.
    International Clinical Psychopharmacology 07/2014; 29(4):224-228. DOI:10.1097/YIC.0000000000000021
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    • "Using as few medications as possible to target central areas of clinical dysfunction, together with evidence-based psychotherapy, is usually the optimal treatment strategy. In light of this, although the 2001 guidelines suggest a prominent role for serotonergic pharmacotherapy, recent reviews have questioned this and instead emphasized anticonvulsants and antipsychotics (Abraham & Calabrese, 2008 ; Mercer et al. 2009). "
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    ABSTRACT: Patients with personality disorders are prescribed psychotropic medications with greater frequency than almost any other diagnostic group. Prescribing practices in these populations are often based on anecdotal evidence rather than rigorous data. Although evidence-based psychotherapy remains an integral part of treatment, Axis II psychopathology is increasingly conceptualized according to neurobiological substrates that correspond to specific psychopharmacological strategies. We summarize the best available evidence regarding medication treatment of personality disordered patients and provide optimal strategies for evidence-based practice. Most available evidence is concentrated around borderline and schizotypal personality disorders, with some additional evidence concerning the treatment of avoidant and antisocial personality disorders. Although maladaptive personality symptoms respond to antidepressants, antipsychotics, mood stabilizers, and other medications, evidence-based pharmacotherapy is most useful in treating circumscribed symptom domains and induces only partial improvement. Most available evidence supports use of medication in reducing impulsivity and aggression, characteristic of borderline and antisocial psychopathology. Efforts have also begun to reduce psychotic-like symptoms and improve cognitive deficits characteristic of schizotypy. Indirect evidence is also provided for psychopharmacological reduction of social anxiety central to avoidant personality disorder. Evidence-based practice requires attention to domains of expected clinical improvement associated with a medication, relative to the potential risks. The development of future rational pharmacotherapy will require increased understanding of the neurobiological underpinnings of personality disorders and their component dimensions. Increasing efforts to translate personality theory and social cognitive neuroscience into increasingly specific neurobiological substrates may provide more effective targets for pharmacotherapy.
    The International Journal of Neuropsychopharmacology 02/2011; 14(9):1257-88. DOI:10.1017/S1461145711000071
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