An open-label trial of divalproex extended-release in the treatment of borderline personality disorder.
BACKGROUND
Borderline personality disorder (BPD) is associated with several symptoms, including impulsivity, aggression, and intense unstable affect, which can be targeted with anticonvulsant agents. Divalproex extended-release (ER) is used widely in clinical practice, which leads to the question of its efficacy and tolerability in treating BPD.


METHODS
This study assessed the efficacy and tolerability of divalproex ER in 20 adult outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BPD via a 12-week open-label trial. Primary outcome measures included the Clinical Global Impression-Improvement (CGI-I) scale and the Global Assessment Scale. Secondary outcome measures assessed aggression (Aggression Questionnaire, Overt Aggression Scale-Modified); affective disturbance (Affective Intensity Measure, Affective Lability Scale); dissociation (Dissociative Experiences Scale); and general psychopathology (Symptom-Checklist 90-Revised).


RESULTS
Thirteen subjects were male and seven were female with a mean age of 37.0+/-11.3 years. Treatment was associated with statistically significant improvement on the CGI-I, the Global Assessment Scale, the Overt Aggression Scale-Modified irritability subscale, and the Aggression Questionnaire. A trend toward significant improvement was observed on the Affective Intensity Measure. Seven out of 10 completers (70%) were treatment responders, with an endpoint CGI-I of 2 (much improved) or 1 (very much improved). There was no significant decline in affective lability or in dissociation. One participant discontinued treatment due to adverse events.


CONCLUSIONS
These findings support that divalproex ER is an efficacious and well-tolerated pharmacologic agent for BPD, with the additional advantage of single daily dosing at bedtime. Placebo-controlled trials are needed for replication.
Simeon
Daphne
D
Department of Psychiatry, the Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA. daphne.simeon@mssm.edu
Baker
Bryann
B
Chaplin
William
W
Braun
Ashley
A
Hollander
Eric
E
D000328:Adult; D000374:Aggression / Q000187:drug effects; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001883:Borderline Personality Disorder / Q000188:drug therapy* / Q000523:psychology; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000188:drug therapy / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D014635:Valproic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D000927:Anticonvulsants; D003692:Delayed-Action Preparations; D014635:Valproic Acid