Topiramate Treatment of Aggression in Female Borderline Personality Disorder Patients

Clinic for Psychosomatic Medicine, Inntalklinik, Simbach/Inn, Germany.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 11/2004; 65(11):1515-9. DOI: 10.4088/JCP.v65n1112
Source: PubMed


The goal of this study was to compare the efficacy and safety of topiramate versus placebo in the treatment of aggression in women who meet the criteria for borderline personality disorder.
We conducted a double-blind, placebo-controlled study of topiramate in 29 female subjects (response rate 93.5%) meeting SCID (Structured Clinical Interview for DSM-IV) criteria for borderline personality disorder. The subjects were randomly assigned in a 2:1 ratio to topiramate (N = 21, analysis based on N = 19) or placebo (N = 10). Treatment lasted 8 weeks (November 2003-January 2004). Primary outcome measures were self-reported changes on the anger subscales of the State-Trait Anger Expression Inventory (STAXI).
Significant improvements on 4 subscales of the STAXI (state-anger, trait-anger, anger-out, anger-control) were observed in the topiramate-treated subjects after 8 weeks, in comparison with the placebo group. The difference in improvement in score between the 2 groups for state-anger, trait-anger, and anger-out ranged from 21% to 24%, and the difference for anger-control was -13%. As an exception, a difference of only 8.5% (p < .2) was found on the anger-in subscale. Significantly greater weight loss was observed in the topiramate-treated group than in those treated with placebo (difference in weight loss between the 2 groups: 2.3 kg [5.1 lb] [3.2%]; 95% CI = 1.3% to 4.4%, p < .01). All patients tolerated topiramate well.
Topiramate appears to be a safe and effective agent in the treatment of anger in women with borderline personality disorder as defined by SCID criteria. Additionally, significant weight loss can be expected.

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    • "As a class, anticonvulsant medications offer moderate-to-large effects on impulsive aggression, affective instability, and overall functioning, with potentially greater effect size than associated with atypical antipsychotic treatment.25,27 Trials with topiramate suggest a broad spectrum of therapeutic benefit, particularly in anger and interpersonal functioning.106-110 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. "
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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.
    Full-text · Article · Jun 2013
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    • "After week 8, dose could be further increased to maximum of 20 mg/d. Most patients received less than 10 mg/d Parallel design, 12 wk Superior to placebo on CGI and CGI-BPD Nickel et al. (2004) BPD 31 females Topiramate Began with 50 mg/d, then increased to 250 mg/d by last 3 wk "
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    Full-text · Article · Feb 2011 · The International Journal of Neuropsychopharmacology
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    • "Topiramate has been shown to be an effective treatment for aggression in adult populations with borderline personality disorders in double blind placebo controlled trials, with improvements maintained at 18 month follow up [42,43,44]. Based on 14 open label studies, the drug had an overall 58% response rate in 279 adult patients with Bipolar disorder [1]. "
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    ABSTRACT: Aggressive symptomatology presents across multiple psychiatric, developmental, neurological and behavioral disorders, complicating the diagnosis and treatment of the underlying pathology. Anti-Epileptic Drugs (AEDs) have become an appealing alternative in the treatment of aggression, mood lability and impulsivity in adult and pediatric populations, although few controlled trials have explored their efficacy in treating pediatric populations. This review of the literature synthesizes the available data on ten AEDs – valproate, carbamazepine, oxcarbazepine, phenytoin, lamotrigine, topiramate, levetiracetam, zonisamide, gabapentin and tiagabine – in an attempt to assess evidence for the efficacy of AEDs in the treatment of aggression in pediatric populations. Our review revealed modest evidence that some of the AEDs produced improvement in pediatric aggression, but controlled trials in pediatric bipolar disorder have not been promising. Valproate is the best supported AED for aggression and should be considered as a first line of treatment. When monotherapy is insufficient, combining an AED with either lithium or an atypical anti-psychotic can result in better efficacy. Additionally, our review indicates that medications with predominately GABA-ergic mechanisms of action are not effective in treating aggression, and medications which decrease glutaminergic transmission tended to have more cognitive adverse effects. Agents with multiple mechanisms of action may be more effective.
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