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

Abstract

BACKGROUND:

Many patients with borderline personality disorder receive pharmacological treatment, but there is uncertainty about the usefulness of such therapies.

AIMS:

To evaluate the evidence of effectiveness of pharmacotherapy in treating different facets of the psychopathology of borderline personality disorder.

METHOD:

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.

RESULTS:

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.

CONCLUSIONS:

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.

• Authors: Klaus Lieb, Birgit Völlm, Gerta Rücker, Antje Timmer, Jutta M Stoffers
• Journal: The British journal of psychiatry : the journal of mental science (Br J Psychiatry) Vol. 196 Issue 1 Pg. 4-12 (Jan 2010) ISSN: 1472-1465 [Electronic] England
• PMID: 20044651 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Chemical References

• Antidepressive Agents
• Antipsychotic Agents
• Fatty Acids, Omega-3
• Serotonin Uptake Inhibitors

Topics

• Antidepressive Agents (therapeutic use)
• Antipsychotic Agents (therapeutic use)
• Borderline Personality Disorder (drug therapy)
• Drug Therapy, Combination
• Fatty Acids, Omega-3 (therapeutic use)
• Female
• Humans
• Male
• Randomized Controlled Trials as Topic (standards)
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Treatment Outcome