Lamotrigine treatment of aggression in female borderline patients, Part II: An 18-month follow-up

Inntalklink, Simbach am Inn, Germany.
Journal of Psychopharmacology (Impact Factor: 3.59). 03/2008; 22(7):805-8. DOI: 10.1177/0269881107084004
Source: PubMed


Borderline patients often display pathological aggression. We previously tested lamotrigine, an anti-convulsant, in therapy for aggression in women with borderline personality disorder (BPD) (J Psychopharmacol 2005; 19: 287-291), and found significant changes on most scales of the State-Trait Anger Expression Inventory (STAXI) after eight weeks. To assess the longer-term efficacy of lamotrigine in therapy for aggression in women with BPD, this 18-month follow-up observation was carried out, in which patients (treated with lamotrigine: n = 18; former placebo group: n = 9) were tested every six months. According to the intent-to-treat principle, significant changes on all scales of the STAXI were observed in the lamotrigine-treated subjects. All subjects tolerated lamotrigine relatively well. Lamotrigine appears to be an effective and relatively safe agent in the longer-term treatment of aggression in women with BPD.

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    • "However, adverse cognitive sequelae may interfere with psychotherapy for some BPD patients, and potential weight loss may become troubling for patients with comorbid eating disorders. Lamotrigine treatment improves impulsivity, affective symptoms,111 and aggression,41,112 but it requires lengthy titration to avoid life-threatening rash and toxicity. Valproate appears to be particularly efficacious in BPD patients with prominent impulsive aggression, rather than affective instability.113 "
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    ABSTRACT: The best available evidence for psychopharmacologic treatment of borderline personality disorder (BPD) is outlined here. BPD is defined by disturbances in identity and interpersonal functioning, and patients report potential medication treatment targets such as impulsivity, aggression, transient psychotic and dissociative symptoms, and refractory affective instability Few randomized controlled trials of psychopharmacological treatments for BPD have been published recently, although multiple reviews have converged on the effectiveness of specific anticonvulsants, atypical antipsychotic agents, and omega-3 fatty acid supplementation. Stronger evidence exists for medication providing significant improvements in impulsive aggression than in affective or other interpersonal symptoms. Future research strategies will focus on the potential role of neuropeptide agents and medications with greater specificity for 2A serotonin receptors, as well as optimizing concomitant implementation of evidence-based psychotherapy and psychopharmacology, in order to improve BPD patients' overall functioning.
    06/2013; 15(2):213-24.
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    • "In an 18-month follow-up observation study, these patients (lamotrigine group, n = 18; former placebo group, n = 9 (took neither lamotrigine nor placebo) were tested every six months [146]. The lamotrigine group experienced significantly greater changes on all STAXI scales compared to the ex-placebo group. "
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