Many patients with borderline personality disorder receive pharmacological treatment, but there is uncertainty about the usefulness of such therapies.
To evaluate the evidence of effectiveness of pharmacotherapy in treating different facets of the psychopathology of borderline personality disorder.
A Cochrane Collaboration systematic review and meta-analysis of randomised comparisons of drug v. placebo, drug v. drug, or single drug v. combined drug treatment in adult patients with borderline personality disorder was conducted. Primary outcomes were overall disorder severity as well as specific core symptoms. Secondary outcomes comprised associated psychiatric pathology and drug tolerability.
Twenty-seven trials were included in which first- and second-generation antipsychotics, mood stabilisers, antidepressants and omega-3 fatty acids were tested. Most beneficial effects were found for the mood stabilisers topiramate, lamotrigine and valproate semisodium, and the second-generation antipsychotics aripiprazole and olanzapine. However, the robustness of findings is low, since they are based mostly on single, small studies. Selective serotonin reuptake inhibitors so far lack high-level evidence of effectiveness.
The current evidence from randomised controlled trials suggests that drug treatment, especially with mood stabilisers and second-generation antipsychotics, may be effective for treating a number of core symptoms and associated psychopathology, but the evidence does not currently support effectiveness for overall severity of borderline personality disorder. Pharmacotherapy should therefore be targeted at specific symptoms.
"There is a paucity of useful pharmacotherapies that might be used independent of or as a complement to psychosocial treatment programs. The Cochrane group has identified 33 RCTs of pharmacotherapeutic interventions for adults with BPD (Stoffers & Lieb, 2015; Stoffers et al., 2010) as well as second-generation antipsychotics, mood stabilizers, and omega-3 PUFAs as promising agents. Other agents of interest that have yet to be formally tested in RCTs include those targeting N-methyl-D-aspartate signaling, and neuropeptides such as opioids and oxytocin (Bateman et al., 2015). "
"On one hand, the psychiatrists used all types of medication for nearly every patient, but on the other they stated that they expected a definite improvement only in a quarter of the treated patients. In addition, Table 2 Medication in borderline personality disorder treatment: group of psychiatrists in this study vs. Cochrane systematic review (Lieb et al., 2010) Type of medication Psychiatrists in this study Cochrane review (based on 27 studies, with 1714 participants in total) "
[Show abstract][Hide abstract] 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 · 2.46 Impact Factor
"By contrast, there is little evidence of utility for people with personality disorder. Current guidelines give limited support for medication7-9 and no clear justification for long-term medication.10,11 Consequently, psychiatrists encounter patients with personality disorder with persisting symptoms, disability and unmet needs.12 "
[Show abstract][Hide abstract] ABSTRACT: Aims and method To explore experiences of psychiatrists considering medication for patients with personality disorder by analysis of transcribed, semi-structured interviews with consultants.
Results Themes show important relational processes in which not prescribing is expected to be experienced as uncaring rejection, and psychiatrists felt helpless and inadequate as doctors when unable to relieve symptoms by prescribing. Discontinuity in doctor-patient relationships compounds these problems.
Clinical implications Problems arise from: (a) the psychopathology creating powerful relational effects in consultation; (b) the lack of effective treatments, both actual and secondary to under-resourcing and neglect of non-pharmaceutical interventions; and (c) the professionally constructed role of psychiatrists prioritising healing and cure through provision of technological interventions for specific diagnoses. There is a need for more treatments and services for patients with personality disorder; more support and training for psychiatrists in the relational complexities of prescribing; and a rethink of the trend for psychiatrists to be seen primarily as prescribers.
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