Evidenced-based pharmacologic treatment of borderline personality disorder: a shift from SSRIs to anticonvulsants and atypical antipsychotics?
OBJECTIVE
The authors performed a review of double-blind, controlled studies of psychotropic drugs to evaluate the evidence base supporting their use in treatment of borderline personality disorder.


METHODS
English language literature cited in Medline and published between 1970 and 2006 was searched using the following terms: anticonvulsants, antidepressants, antipsychotics, anxiolytics, benzodiazepines, borderline personality disorder, lithium, medication, mood stabilizers, pharmacotherapy, and psychotropics. Only reports of double-blind, randomized, controlled trials were included.


RESULTS
Twenty eight double-blind, randomized, controlled trials were identified which included anticonvulsants, classical neuroleptics, the benzodiazepine alprazolam, lithium, monoamine oxidase inhibitors, the novel antipsychotic olanzapine, selective serotonin reuptake inhibitors, tricyclic antidepressants, and omega-3 fatty acids. All but three were placebo-controlled. With the exception of alprazolam and tricyclics, the data from these trials revealed evidence of improvements, although often circumscribed and variable. The novel antipsychotic olanzapine appeared to have the most empirical support for having a favorable effect on borderline personality disorder.


CONCLUSIONS
A growing body of data suggests that there are psychotropic agents which appear to be well tolerated, and which to varying degrees may be expected to ameliorate the domains of psychopathology associated with borderline personality disorder. The research literature, on which practice should be optimally based, appears to suggest a need for a shift from antidepressants to anticonvulsants and atypical antipsychotics.
Abraham
P Francis
PF
pabraham@nordcenter.org
Calabrese
Joseph R
JR
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D010919:Placebos; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors