Meta-analyses of mood stabilizers, antidepressants and antipsychotics in the treatment of borderline personality disorder: effectiveness for depression and anger symptoms.
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 double-blind 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 studies excluded patients with alcohol and substance abuse, suicidality, and self-harm behaviors. This may limit the ability to generalize our findings to usual clinical practice.
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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 · 1.31 Impact Factor
European Neuropsychopharmacology 10/2012; 22:S305. DOI:10.1016/S0924-977X(12)70465-0 · 5.40 Impact Factor