Evidence for the use of pharmacotherapy in the treatment of borderline personality disorder (BPD) appears to be limited and of low quality, according to the findings of a systematic review recently published in CNS Drugs.

While no drugs are currently approved for the treatment of BPD, nearly all patients with this condition receive at least 1 psychotropic medication. The aim of the review was to evaluate the efficacy, as well as compare the effectiveness, of various pharmacological therapies used in the management of BPD.

The authors searched MEDLINE, EMBASE, the Cochrane Library, and PsycINFO for studies assessing the use of drug therapy in BPD patients at least 13 years old. Treatments included anticonvulsive medications, antidepressants, antipsychotic medications, benzodiazepines, melatonin, opioid agonists or antagonists, and sedative/hypnotic medications.

The analysis included 21 randomized controlled trials with a total of 1768 patients, of the 87 medications utilized in clinical practice, studies on only 9 agents were found. “Overall, the evidence indicates that the efficacy of pharmacotherapies for the treatment of BPD is limited,” the authors reported.


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Findings also showed that the severity of BPD was not consistently reduced in patients who received second-generation antipsychotics, anticonvulsants, or antidepressants. Although improvements were observed for specific BPD symptoms (anger, aggression, affective lability) in patients who received anticonvulsants, this finding was based on low-certainty evidence which was mostly limited to single studies.

Though second-generation antipsychotics were found to have “little effect” on the severity of specific symptoms of BPD, these agents did improve general psychiatric symptoms.

Study limitations included a lack of high-quality evidence; most studies were small and assessed only short-term outcomes. Additionally, the study population was limited mostly to white women; therefore the findings may not be generalizable to other populations.

“Overall, the efficacy of pharmacotherapies to improve BPD is limited to improvement of individual symptoms but not the condition overall,” the authors concluded. “Even for the improvement of symptoms, the certainty of evidence is low.”

Reference

Gartlehner G, Crotty K, Kennedy S, et al. Pharmacological treatments for borderline personality disorder: A systematic review and meta‑analysis. CNS Drugs. Published online September 8, 2021. doi: 10.1007/s40263-021-00855-4.