New research published in the August issue of Psychiatric Annals evaluates the results of randomized control trials on the use of various psychotropic drugs for patients diagnosed with borderline personality disorder (BPD). Despite the “American Psychiatric Association’s practice guidelines endorsement of SSRIs as first-line therapies for BPD,” the results of the meta-analysis reveal that pharmacotherapy in BPD is “not supported by the current literature,” and “should be avoided whenever possible.”
The Borderline Personality Disorder diagnosis, according to the NIH, is characterized by problems regulating emotions and thoughts, reckless behavior, and unstable relationships. However, it is evident the BPD is often misdiagnosed, and the National Comorbidity Survey Replication study reveals that 85% of people diagnosed with BPD also meet the DSM diagnostic criteria for other disorders.
Currently, the FDA has not approved any medications for BPD but, as the researchers point out, “approximately 80% of patients with the disorder take medications regularly, and more than 40% take three or more medications daily.”
The recent review of the research examined randomized control trial studies on the efficacy of antidepressants, mood stabilizers, and antipsychotics in BPD published prior to 2015. The researchers found no statistically significant effects for SSRI antidepressants on BPD. There was limited statistical power for studies on mood stabilizers though certain drugs were observed to have a limited impact on specific symptoms, such as anger or interpersonal sensitivity.
Similarly, research on antipsychotics was limited to effects on specific symptoms associated with BPD. The review also examined several studies on the effects of omega-3 fatty acids on BPD and reported significant improvements in “characteristic BPD symptoms” such as impulsive behavioral control, outbursts of anger, self-mutilating conduct, as well as reductions in aggressive behaviors and depressive symptoms.
The reviewers caution that the RCT results are limited by small size, short duration, high dropout rates, inconsistent outcome measures, enrollment biases, and lack of replication. They conclude that “the mainstay treatment for BPD is still psychotherapy,” and that “polypharmacy should be avoided whenever possible,” while also signaling some support for symptom-specific pharmacologic therapies.
The results of the review are in line with the World Federation of Societies of Biological Psychiatry guidelines for biological treatment of personality disorders, which conclude that “there is no evidence at either level of evidence that any drug improves BPD psychopathology in general.”
Francois, D., Roth, S. D., & Klingman, D. (2015). The Efficacy of Pharmacotherapy for Borderline Personality Disorder: A Review of the Available Randomized Controlled Trials. Psychiatric Annals, 45(8), 431. (Full Text)