Meta-Analyses of Mood Stabilizers, Antidepressants and Antipsychotics in the Treatment of Borderline Personality Disorder: Effectiveness for Depression and Anger Symptoms

ArticleinJournal of personality disorders 23(2):156-74 · May 2009with32 Reads
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
    • "However, subjects with ADHD and PD did improve in their core ADHD symptoms, especially emotional dysregulation , but also oppositional defiant symptoms. Second, several medication studies report that psychotropic medications may impact emotional symptoms connected with borderline personality (Ingenhoven and Duivenvoorden, 2011; Lieb et al., 2010; Mercer et al., 2009; Vita et al., 2011) and severe PD (Ingenhoven et al., 2010). Conversely, none of these studies documented improvement in the areas of self-perception and interpersonal functioning assessed by the WISPI-IV. "
    [Show abstract] [Hide abstract] ABSTRACT: Personality disorders (PDs) are commonly found in adults with attention-deficit/hyperactivity disorder (ADHD) and are associated with increased ADHD symptoms and psychosocial impairment. To assess the impact of PDs or personality traits on retention rates in ADHD trials and whether treating ADHD affects the expression of PD, data were analyzed from 2 methylphenidate trials. Assessment of PDs and personality traits included using the Wisconsin Personality Disorders Inventory IV and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Personality Disorders. Attention-deficit/hyperactivity disorder symptoms were evaluated using the Wender-Reimherr Adult Attention Deficit Disorder Scale. Major findings were that subjects with cluster A, cluster B, passive-aggressive, or more than 1 PD showed more attrition. Subjects dropping out also had more schizoid and narcissistic traits. Attention-deficit/hyperactivity disorder symptoms (p < 0.001) and all personality traits (range, p = 0.03 to p = 0.001) improved, but there was almost no correlation between changes on these 2 measures. Conversely, of 11 Wisconsin Personality Disorders Inventory IV items that improved most, 8 resembled ADHD or oppositional defiant disorder symptoms. Copyright
    Article · May 2016
    • "Furthermore, the finding of higher severity of comorbid depression in individuals with BPD is in line with longitudinal studies indicating later remission of depression in BPD (e.g., Levenson, Wallace, Fournier, Rucci, & Frank, 2012) as compared to depressed patients without personality disorders. Furthermore, results of a longitudinal study by Gunderson et al. (2004) suggest that improvements in BPD are followed by improvements in depression symptoms, but not vice versa, and meta-analytic findings indicate that antidepressants have a rather small effect on depression symptoms in BPD (Mercer, Douglass, & Links, 2009). These findings call for a broad theoretical scope and qualification of therapists, as symptom-oriented methods that do not take into account structural deficits in self-concept and regulatory functions may fall short in patients with comorbid personality disorders (Levy & Anderson, 2013; Milrod, Leon, Barber, Markowitz, & Graf, 2007). "
    [Show abstract] [Hide abstract] ABSTRACT: Depression in borderline personality disorder (BPD) is hypothesized to be distinct in quality and severity. This paper provides a systematic review of depression quality, and a meta-analysis of depression severity in BPD patients compared to those with depressive disorders (DeDs) only. Based on a systematic literature search, 26 studies were identified for systematic review and 35 studies (3425 participants) were included for meta-analysis. The review focused on different forms of depressive symptoms, affective impairment, self-evaluation, and negative interpersonal experiences. The meta-analysis examined age, gender, presence of comorbid DeDs in BPD patients, and type of depression scale as moderators of effect sizes. Findings indicate that depression quality in BPD is characterized by higher anger/hostility and self-criticism. There was no significant difference in depression severity between BPD and DeD groups, and a high level of heterogeneity. Moderator analyses revealed lower depression severity in BPD patients without comorbid DeDs, but higher severity in BPD patients with comorbid DeDs compared to depressed controls. Our results suggest high variability in depression severity across BPD patients, point toward the consideration of comorbid DeDs, and lend partial support to a BPD-specific depression quality. We discuss difficulties in research on depression in BPD, and offer directions for future studies. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Feb 2015
    • "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. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Patients with both major depression and personality disorders have a high risk of suicidal behavior. Lithium is meant to have anti-suicidal properties in patients with affective disorders. The anti-suicidal 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 (PD) 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 related to suicidal behavior could be detected between the placebo group and the group with lithium intervention. Conclusions: On the basis of the small sample size, among patients with comorbid PD, lithium does not seem to have an effect on suicidal behavior in contrast to patients with affective disorders without comorbid PD.
    Full-text · Article · Jul 2014
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