A Focused Systematic Review of Pharmacological Treatment for Borderline Personality Disorder
- 1.6k Downloads
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.
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.
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.
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.
KeywordsOlanzapine Borderline Personality Disorder Aripiprazole Naltrexone Mood Stabiliser
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.
No funding was used in the preparation of this manuscript.
- 1.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC; 2013.Google Scholar
- 3.Gunderson JG, Links P. Borderline personality disorder: a clinical guide. 2nd ed. Washington, DC: American Psychiatric Press, Inc; 2008.Google Scholar
- 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
- 7.National Institute for Health and Clinical Excellence. Borderline personality disorder: recognition and management. 2009. https://www.nice.org.uk/guidance/cg78).
- 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.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.
- 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
- 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.
- 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
- 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
- 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.Selective serotonin reuptake inhibitors (SSRIs) in borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01103180. Accessed 11 Oct 2016.
- 34.A novel drug for borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT02097706. Accessed 11 Oct 2016.
- 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.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.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.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.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.The effects of oxytocin on patients with borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01243658. Accessed 11 Oct 2016.
- 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.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.Guanfacine to treat borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT00358969. Accessed 11 Oct 2016.
- 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.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.PET imaging and olanzapine treatment in borderline personality disorder. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT00275301. Accessed 11 Oct 2016.
- 47.Acetaminophen and social processes. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT02108990. Accessed 11 Oct 2016.
- 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