Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials.
BACKGROUND
Many patients with borderline personality disorder receive pharmacological treatment, but there is uncertainty about the usefulness of such therapies.


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


METHODS
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.
Lieb
Klaus
K
Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Untere Zahlbacher Str. 8, D-55131 Mainz, Germany. Klaus.lieb@ukmainz.de
Völlm
Birgit
B
Rücker
Gerta
G
Timmer
Antje
A
Stoffers
Jutta M
JM
D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001883:Borderline Personality Disorder / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D015525:Fatty Acids, Omega-3; D017367:Selective Serotonin Reuptake Inhibitors