Advertisement

CNS Drugs

, Volume 31, Issue 5, pp 345–356 | Cite as

A Focused Systematic Review of Pharmacological Treatment for Borderline Personality Disorder

  • Ella Hancock-Johnson
  • Chris Griffiths
  • Marco Picchioni
Systematic Review

Abstract

Background

Medicines are routinely prescribed to treat borderline personality disorder (BPD) despite a relative lack of high-quality evidence and in breach of some treatment guidelines. An earlier Cochrane review of pharmacotherapy in BPD underlined the lack of evidence, encouraged the replication of earlier studies, but also emphasised the pressing need for more randomised placebo-controlled trials, and for those studies to employ broadened inclusion criteria.

Method

The authors searched bibliographic databases, reference lists of articles and trials registers. Records were screened to identify those that met the inclusion criteria. Full-text articles were screened and assessed for eligibility. On-going trials of pharmacotherapy in BPD were also identified.

Results

Fifteen new studies of pharmacotherapy for BPD were identified since the earlier review. Eight of those examined second generation antipsychotics, two investigated mood stabilisers, three investigated antidepressants and two studied the effectiveness of opioid antagonists. Results for the effectiveness of antipsychotics appeared to be mixed. There has been little recent evidence to support the use of mood stabilisers. There is a lack of new placebo-controlled, randomised controlled trials investigating antidepressants and limited new evidence to support the use of opioid antagonists.

Conclusions

The review revealed that there remains a dearth of high-quality research evidence to help patients, carers and clinicians make sound and safe evidence-based decisions about medicines to treat BPD.

Keywords

Olanzapine Borderline Personality Disorder Aripiprazole Naltrexone Mood Stabiliser 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Compliance with Ethical Standards

Conflicts of interest

Marco Picchioni has served on an advisory board for Galen Health Partners. Ella Hancock-Johnson and Chris Griffiths have no conflicts of interest to declare.

Funding

No funding was used in the preparation of this manuscript.

References

  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC; 2013.Google Scholar
  2. 2.
    Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey replication. Biol Psychiatry. 2007;62:533–45.CrossRefGoogle Scholar
  3. 3.
    Gunderson JG, Links P. Borderline personality disorder: a clinical guide. 2nd ed. Washington, DC: American Psychiatric Press, Inc; 2008.Google Scholar
  4. 4.
    Zanarini MC, Frankenburg FR, Reich DB, Silk KR, Hudson JI, McSweeney LB. The subsyndromal phenomenology of borderline personality disorder: a 10-year follow-up study. Am J Psychiatry. 2007;164:929–35.CrossRefPubMedGoogle Scholar
  5. 5.
    Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Attainment and stability of sustained symptomatic remission and recover among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry. 2012;169:476–83.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Olabi B, Hall J. Borderline personality disorder: current drug treatments and future prospects. Ther Adv Chronic Dis. 2010;2010(1):59–66.CrossRefGoogle Scholar
  7. 7.
    National Institute for Health and Clinical Excellence. Borderline personality disorder: recognition and management. 2009. https://www.nice.org.uk/guidance/cg78).
  8. 8.
    National Institute for Health and Clinical Excellence. Borderline personality disorder: recognition and management. 2015. https://www.nice.org.uk/guidance/CG78/documents/cg78-borderline-personality-disorder-bpd-surveillance-review-decision-january-20153.
  9. 9.
    Australian Government National Health and Medical Research Council. Clinical practice guideline for the management of borderline personality disorder. 2012. https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/mh25_borderline_personality_guideline.pdf.
  10. 10.
    American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder. Am J Psychiatry. 2001;158:1–52.CrossRefGoogle Scholar
  11. 11.
    Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M. Borderline personality disorder. Lancet. 2004;364:453–61.CrossRefPubMedGoogle Scholar
  12. 12.
    Paton C, Crawford MJ, Bhatti SF, Patl MX, Barnes TR. The use of psychotropic medication in patients with emotionally unstable personality disorder under the care of UK mental health services. J Clin Psychiatry. 2015. doi: 10.4088/JCP.14m09228.PubMedGoogle Scholar
  13. 13.
    Bridler R, Häberle A, Müller ST, Cattapan K, Grohmann R, Toto S. Kasper, Greil W. Psychopharmacological treatment of 2195 in-patient with borderline personality disorder: a comparison with other psychiatric disorders. Eur Neuropsychopharmacol. 2015;25:763–72.CrossRefPubMedGoogle Scholar
  14. 14.
    Binks CA, Fenton M, McCarthy L, Lee T, Adams CE, Duggan C. Pharmacological interventions for people with borderline personality disorder. Cochrane Database Syst Rev. 2006; CD005652.Google Scholar
  15. 15.
    Stoffers J, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K. Pharmacological interventions for borderline personality disorder (review). Cochrane Database Syst Rev. 2010. doi: 10.1002/14651858.CD005653.pub2.Google Scholar
  16. 16.
    Higgins JPT, Altman DG, Sterne JAC. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011. http://www.cochrane-handbook.org.
  17. 17.
    Black DW, Zanarini MC, Romine A, Shaw M, Allen J, Schulz SC. Comparison of low and moderate dosages of extended-release quetiapine in borderline personality disorder: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry. 2014;171:1174–82.CrossRefPubMedGoogle Scholar
  18. 18.
    Moen R, Freitag M, Miller M, Lee S, Romine A, Song S, Adityanjee A, Schulz SC. Efficacy of extended-release divalproex combined with “condensed” dialectical behaviour therapy for individuals with borderline personality disorder. Ann Clin Psychiatry. 2012;24:255–60.PubMedGoogle Scholar
  19. 19.
    Schmahl C, Kleindienst N, Limberger M, Ludäscher P, Mauchnik J, Deibler P, Brünen S, Hiemke C, Lieb K, Herpertz S, Reicherzer M, Berger M, Bohus M. Evaluation of naltrexone for dissociative symptoms in borderline personality disorder. Int Clin Psychopharmacol. 2012;27:61–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Shafti SS, Shahveisi B. Olanzapine versus haloperidol in the management of borderline personality disorder. J Clin Psychopharmacol. 2010;30:44–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Zanarini MC, Schulz SC, Detke HC, Tanaka Y, Zhao F, Lin D, Deberdt W, Kryzhanovskaya L, Corya S. A dose comparison of olanzapine for the treatment of borderline personality disorder: a 12-week randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2011;72:1353–62.CrossRefPubMedGoogle Scholar
  22. 22.
    Bellino S, Rinaldi C, Bogetto F. Adaptation of interpersonal psychotherapy to borderline personality disorder: a comparison of combined therapy and single pharmacotherapy. Can J Psychiatry. 2010;55:74–81.CrossRefPubMedGoogle Scholar
  23. 23.
    Bellino S, Bozzatello P, Rocca G, Bogetto F. Efficacy of omega-3 fatty acids in the treatment of borderline personality disorder: a study of the association with valproic acid. J Psychopharmacol. 2014;28:125–32.CrossRefPubMedGoogle Scholar
  24. 24.
    Jariani M, Saaki M, Nazari H, Birjandi M. The effect of olanzapine and sertraline on personality disorder in patients with methadone maintenance therapy. Psychiatria Danubina. 2010;22:544–7.PubMedGoogle Scholar
  25. 25.
    Shafti SS, Kaviani H. A comparative study on olanzapine and aripiprazole for symptom management in female patients with borderline personality disorder. Bull Clin Psychopharmacol. 2015;25:38–43.CrossRefGoogle Scholar
  26. 26.
    Zanarini MC, Schulz SC, Detke H, Zhao F, Lin D, Pritchard M, Deberdt W, Fitzmaurice G, Cora S. Open-label treatment with olanzapine for patients with borderline personality disorder. J Clin Psychopharmacol. 2012;32:398–402.CrossRefPubMedGoogle Scholar
  27. 27.
    Bozzatello P, Bellino S. Combined therapy with interpersonal psychotherapy adapted for borderline personality disorder: a two-years follow-up. Psychiatry Res. 2016;240:151–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Bellino S, Paradiso E, Bozzatello P, Bogetto F. Efficacy and tolerability to duloxetine in the treatment of patients with borderline personality disorder: a pilot study. J Psychopharmacol. 2010;24:333–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Bellino S, Bozzatello P, Rinaldi C, Bogetto F. Paliperidone ER in the treatment of borderline personality disorder: a pilot study of efficacy and tolerability. Depress Res Treat. 2011. doi: 10.1155/2011/680194.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Van den Eynde F, De Saedeleer S, Naudts K, Day J, Vogels C, van Heeringen C, Audenaert K. Quetiapine treatment and improved cognitive functioning in borderline personality disorder. Hum Psychopharm Clin. 2009;24:646–9.CrossRefGoogle Scholar
  31. 31.
    Martín-Blanco A, Patrizi B, Soler J, Gasol X, Elices M, Gasol M, Carmona C, Pascual JC. Use of nalmefene in patients with comorbid borderline personality disorder and alcohol use disorder: a preliminary report. Int Clin Psychopharmacol. 2017. doi: 10.1097/YIC.0000000000000170.PubMedGoogle Scholar
  32. 32.
    Treating suicidal behavior and self-mutilation in people with borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT00533117. Accessed 11 Oct 2016.
  33. 33.
    Selective serotonin reuptake inhibitors (SSRIs) in borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01103180. Accessed 11 Oct 2016.
  34. 34.
    A novel drug for borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT02097706. Accessed 11 Oct 2016.
  35. 35.
    The effect of oxytocin administration on interpersonal cooperation in borderline personality disorder patients and healthy adults. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT02225600. Accessed 11 Oct 2016.
  36. 36.
    Seroquel extended release (XR) for the management of borderline personality disorder (BPD). ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT00880919. Accessed 11 Oct 2016.
  37. 37.
    Clinical research study to evaluate selegiline in the treatment of borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01912391. Accessed 11 Oct 2016.
  38. 38.
    A double blind crossover study on the effect of MPH on decision-making ability of adults with BPD compared to adults with ADHD and healthy adults. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01426984. Accessed 11 Oct 2016.
  39. 39.
    Preliminary trial of the effect of glucocorticoid receptor antagonist on borderline personality disorder (BPD). ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01212588. Accessed 11 Oct 2016.
  40. 40.
    The effects of oxytocin on patients with borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01243658. Accessed 11 Oct 2016.
  41. 41.
    Low-dose risperidone treatment for subjects suffering from borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT00633802. Accessed 11 Oct 2016.
  42. 42.
    Lamotrigine and borderline personality disorder: Investigating long-term effectiveness. EU Clinical Trials Register. https://www.clinicaltrialsregister.eu/ctr-search/trial/2012-003136-23. Accessed 11 Oct 2016.
  43. 43.
    Guanfacine to treat borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT00358969. Accessed 11 Oct 2016.
  44. 44.
    Botulinum Toxin A for emotional stabilization in borderline personality disorder (BPD (BTX-BPD). ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT02728778. Accessed 11 Oct 2016.
  45. 45.
    Comparing treatments for self-injury and suicidal behavior in people with borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT00834834. Accessed 11 Oct 2016.
  46. 46.
    PET imaging and olanzapine treatment in borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT00275301. Accessed 11 Oct 2016.
  47. 47.
    Acetaminophen and social processes. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT02108990. Accessed 11 Oct 2016.
  48. 48.
    Schulz SC, Zanarini MC, Bateman A, Bohus M, Detke HC, Trzaskoma Q, Tanaka Y. Lin, Deberdt W, Corya S. Olanzapine for the treatment of borderline personality disorder: variable dose 12-week randomised double-blind placebo-controlled study. Br J Psychiatry. 2008;193:485–92.CrossRefPubMedGoogle Scholar
  49. 49.
    Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. Am J Psychiatry. 2004;161:2108–14.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.St Andrew’s Academic DepartmentSt Andrew’s HealthcareNorthamptonUK
  2. 2.Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK

Personalised recommendations