Article

Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials

Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Untere Zahlbacher Str. 8, D-55131 Mainz, Germany.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.34). 01/2010; 196(1):4-12. DOI: 10.1192/bjp.bp.108.062984
Source: PubMed

ABSTRACT 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.

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    • "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). "
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    • "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) "
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    • ", but has not yet responded to a challenge from a Cochrane systematic review that followed shortly afterwards that reached different conclusions [Lieb et al. 2010]. "
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