Journal
JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY
Volume 31, Issue 5, Pages 613-624Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/JCP.0b013e31822c1636
Keywords
borderline personality disorder; antidepressants; antipsychotics; anticonvulsants; placebo; meta-analysis
Categories
Funding
- Health Authority of Lombardy Region
- Ministry of Research
- University of Brescia
- Stroder
- European Psychiatric Association
- University of Brescia School of Medicine
- Janssen Cilag
- Lundbeck
- Rottapharm
- Servier
- Health Authority of Lombardy [153]
- Eulo University Study of Brescia
- MIUR
- AstraZeneca
- Eli Lilly
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The aim of this study was to quantitatively review randomized controlled trials (RCTs) and open-label trials analyzing the efficacy of antidepressants, mood stabilizers, and antipsychotics for the treatment of the core symptoms of borderline personality disorder (BPD). Using a similar meta-analytic approach, the efficacy of placebo on the same core symptoms of BPD was evaluated. The risk of discontinuation of each of the medication classes reported in the studies was also analyzed to establish the major causes of discontinuation. MEDLINE (1966 to June 2010) and EMBASE (1980 to June 2010) databases were systematically searched to identify relevant RCTs and open studies. The primary outcome was improvement in the specific core symptoms of the disorder: affective dysregulation, impulsive-behavioral dyscontrol, and cognitive-perceptual symptoms. Evidence from RCTs and open studies suggests that drug treatment, especially with mood stabilizers and antipsychotics, may be effective for treating affective dysregulation and impulsive-behavioral dyscontrol. Antipsychotics were also effective in reducing cognitive-perceptual symptoms. Antidepressants failed to show efficacy in treating BPD symptom dimensions other than affective dysregulation. Our analyses of the placebo arm of RCTs showed a significant improvement of symptomatology in these patients also. There were no significant differences in overall dropout rates between patients on medications and those on placebo. In conclusion, the efficacy of pharmacological treatment on the symptom dimensions of BPD has been shown by various independent meta-analyses, with a positive effect of drug treatment on the core symptoms of BPD and some documentable differences in terms of efficacy between different drug classes in each of the symptom domains.
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