Molecules for borderline personality disorder.
BPD Studies.

.
Studies in this paper
 

Molecule	Studies	Class	Brand name
Alprazolam	(2)	(benzodiazepine)	Xanax, Alprazolam
Amitriptyline	(3)	(Antidepressant Tricyclic)	Amitril, Elavil, etc
Carbamazepine	(3)	(anticonvulsant)	Carbamazepine
Citalopram		(SSRI)	Celexa, seropram...
Clonazepam		(benzodiazepine)	Rivotril, Klonopin
Clozapine	(2)	(atypical neuroleptic)	Clozapine
Divalproex sodium	(3)	(anticonvulsant)	Depakote
Fluoxetine	(3)	(SSRI)	Prozac
Fluvoxamine	(2)	(SSRI)	Floxyfral
Haloperidol	(4)	(neuroleptic)	Haldol
Olanzapine	(4)	(atypical neuroleptic)	Zyprexa
Oxcarbazepine		(anticonvulsant)	Trileptal
Quetiapine	(2)	(atypical neuroleptic)	Seroquel
Risperidone	(3)	(atypical neuroleptic)	Risperdal
Sertraline		(SSRI)	Zoloft
Topiramate		(anticonvulsant)	Epitomax, Topamax
Tranylcypromine		(Antidepressant IMAO)	Parnate
Valproate		(anticonvulsant)	Depakene ??
Venlafaxine	(2)	(SSRI)	Effexor
Ziprazidone		(atypical neuroleptic)	Zeldox

• Miscellaneous

Mazaira S. - Primera Catedra de Farmacologia, Facultad de Medicina, Buenos Aires.
Vertex. 2OO4 Dec-2OO5 Feb - Pharmacological treatment of borderline personality disorder
Borderline personality disorder is characterised by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships and self image. Clinical signs of the disorder include emotional dysregulation, impulsive aggression, repeated self-injury, and chronic suicidal tendencies, which make these patients frequent users of mental health resources. The treatment of this kind of patients (very dependent, with a great tendency to overestimating the power of the drugs prescribed) must be organized over a psychotherapeutic strategy, which will help them to deal with their troublesome relationships. The psychopharmacological approach is useful but is limited, giving the borderline patients a symptomatic relief. When the affective symptoms are the target, drugs like the SSRI antidepressants are the best choice.
If the patient presents a behavioural discontrol pattern, then the psychiatrist will prescribe an SSRI alone or with a mood stabilizer or an antipsychotic. Finally, if the patient has transient psychotic symptoms, then the temporary use of typical or atypical antipsychotics is the rule.
 
• Alprazolam (benzodiazepine)

Gardner, D.L. & Cowdry, R.W.
Am. J. Psychiatry. 1985 - Alprazolam-induced dyscontrol in borderline personality disorder.
The short-acting benzodiazepine alprazolam has been associated with precipitating serious dyscontrol in one placebo-controlled crossover study of patients with BPD
The authors suggest that caution be used in prescribing alprazolam to patients with similar histories.
 
• Alprazolam (benzodiazepine) / carbamazepine and trifluoperazine and tranylcypromine.

Cowdry RW, Gardner DL. - Intramural Research Program, National Institute of Mental Health, Bethesda
Arch Gen Psychiatry. 1988 - Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine.
Physicians rated patients as significantly improved relative to placebo while receiving tranylcypromine and carbamazepine. Patients rated themselves as significantly improved relative to placebo only while receiving tranylcypromine. Patients who tolerated a full trial of trifluoperazine showed improvement, those receiving carbamazepine demonstrated a marked decrease in the severity of behavioral dyscontrol, and those receiving alprazolam had an increase in the severity of the episodes of serious dyscontrol

(Others Benzodiazepine, alprazolam, anxiety disorder studies)
 

• Amitriptyline (Antidepressant Tricyclic)

Soloff PH, George A, Nathan RS, Schulz PM, Perel JM.
1987 Psychopharmacol Bull.23 - Behavioral dyscontrol in borderline patients treated with amitriptyline.
Amitriptyline was associated with a paradoxical behavioral toxicity in patients with BPD, increasing suicidal ideation, paranoid thinking, and assaultiveness significantly more than among placebo nonresponders

Amitriptyline (Antidepressant Tricyclic) / Haloperidol (neuroleptic)
Soloff PH, George A, Nathan S, Schulz PM,... - Western Psychiatric Institute and Clinic, University of Pittsburgh, Pennsylvania.
J Clin Psychopharmacol. 1989 Aug - Amitriptyline versus haloperidol in borderline: final outcomes and predictors of response.
The authors report the final results of a 4-year study of amitriptyline and haloperidol in 90 symptomatic borderline inpatients. Haloperidol produced significant improvement over placebo in global functioning, depression, hostility, schizotypal symptoms, and impulsive behavior.
Significant effects of amitriptyline were generally limited to measures of depression.

Amitriptyline (Antidepressant Tricyclic) / Haloperidol (neuroleptic)
Arch Gen Psychiatry 1986 Jul - Progress in pharmacotherapy of borderline disorders. A double-blind study of amitriptyline, haloperidol, and placebo.
In symptomatic patients with borderline disorder, we conducted a double-blind, placebo-controlled trial of haloperidol and amitriptyline hydrochloride to test the differential efficacy of medication against the affective and schizotypal symptoms that characterize the disorder.
Haloperidol was superior to both amitriptyline and placebo on a composite measure of overall symptom severity, with no difference between amitriptyline and placebo.
Haloperidol produced significant improvement on a broad spectrum of symptom patterns, including depression, anxiety, hostility, paranoid ideation, and psychoticism. In contrast, amitriptyline was minimally effective, with small gains limited to some areas of depressive content.
 

• Carbamazepine (Anticonvulsant)

Denicoff KD, Meglathery SB, Post RM,... - Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD
J Clin Psychiatry. 1994 Feb - Efficacy of carbamazepine compared with other agents: a clinical practice survey.
RESULTS: Carbamazepine was reported to be moderately to markedly effective in the following percentage of
patients: 48.1%; borderline personality disorder
CONCLUSION: Carbamazepine was widely used to treat a variety of psychiatric conditions in 1988 and found to be of use in the acute and long-term treatment of bipolar illness.

Carbamazepine (Anticonvulsant)
Gardner DL, Cowdry RW. -
Am J Psychiatry. 1986 Apr - Positive effects of carbamazepine on behavioral dyscontrol in borderline personality disorder.
In a double-blind crossover trial, carbamazepine, an anticonvulsant with primary effects on subcortical limbic structures, decreased the severity of behavioral dyscontrolin 11 women with borderline personality disorder significantly more than placebo. The authors emphasize the preliminary nature of their findings and discuss alternative hypotheses regarding mechanisms by which carbamazepine might influence behavioral dyscontrol.

Carbamazepine (Anticonvulsant)
Department of Psychiatry, Erasme Hospital, Free University of Brussels (ULB), Belgium.
Eur Neuropsychopharmacol • 1994 Dec - A trial of carbamazepine in borderline personality disorder .
Borderline personality disorder does not have a first choice pharmacological treatment. We studied 20 borderline inpatients in a double-blind parallel placebo-controlled trial with carbamazepine for a mean of 30.9 days. No significant positive effects of the drug were found.
 

• Citalopram(SSRI) / Sertraline(SSRI)

Ekselius L, von Knorring L. - Dept. of Neuroscience, Psychiatry, University Hospital, Uppsala, Sweden.
Int Clin Psychopharmacol. 1998 Sep - "Personality disorder comorbidity with major depression and response to treatment
with sertraline or citalopram."
A total of 308 patients with a major depressive disorder were assessed..., before and after 24 weeks double-blind treatment with sertraline (50-150 mg/day) or citalopram (20-60 mg/day).
Following treatment, significant reductions in the frequency of paranoid, borderline, avoidant and dependent personality disorder diagnoses were seen in both treatment groups.
When the personality disorders were analysed as continuous, dimensional personality traits significant
reductions were seen for most personality categories.
The results suggest that sertraline and citalopram may be beneficial in the treatment of certain personality disorder traits in patients with major depressive disorders.
 
• Clonazepam (benzodiazepine)

Freinhar JP, Alvarez WA
Int J Psychiatry Med. 1985-86 - Clonazepam: a novel therapeutic adjunct.
Clonazepam, a unique benzodiazepine with anticonvulsant and serotonin enhancing capacity, can be used in conjunction with conventional psychopharmacologic agents to treat a variety of psychiatric conditions including schizophrenia, borderline personality disorder, and psychotic mania...
 
• Clozapine(atypical neuroleptic)

Benedetti F, Sforzini L, Colombo C, Maffei C,... - Istituto Scientifico Ospedale San Raffaele, Dept. of Neuropsychiatric Sciences, University of Milan, Italy.
J Clin Psychiatry. 1998 Mar - Low-dose clozapine in acute and continuation treatment of severe borderline personality disorder.
Clozapine lacks the neurologic side effects of traditional neuroleptics and has been shown to successfully treat psychotic-like symptoms in BPD patients at medium dose.
CONCLUSION: Low-dose clozapine for acute and continuation treatment led to improvement in overall symptomatology in a small sample of severe BPD patients.

Clozapine(atypical neuroleptic)
Frankenburg FR, Zanarini MC. - Psychotic Disorders Program, McLean Hospital, Belmont, MA
Compr Psychiatry. 1993 Nov-Dec - Clozapine treatment of borderline patients: a preliminary study.
Clinicians frequently encounter patients who present with borderline personality disorder (BPD) and
prolonged and/or pronounced psychotic symptoms of an atypical nature.
... These results suggest that clozapine may be an effective antipsychotic agent for this subset of BPD patients.
 

• Divalproex sodium (anticonvulsant)

Wilcox JA. - MECCA, Iowa City, Iowa, USA.
Ann Clin Psychiatry. 1995 Mar - Divalproex sodium as a treatment for borderline personality disorder.
Divalproex sodium was given to a series of individuals with the diagnosis of borderline personality disorder. Objective measures of agitation and anxiety were then used to assess the effect of divalproex sodium on such symptoms. Data were collected on the subjects and the amount of time spent in the agitated state was evaluated.
We found that divalproex sodium reduced agitation in our subjects.

Divalproex sodium (anticonvulsant)
Department of Psychiatry, Mount Sinai School of Medicine, New York, USA.
J Clin Psychiatry 2OO1 Mar - A preliminary double-blind, placebo-controlled trial of divalproex sodium in borderline personality
disorder .
Since anticonvulsant agents may be helpful in such symptomatology, we compared divalproex sodium with placebo in patients
with borderline personality disorder.
There was significant improvement from baseline in both global measures following divalproex sodium treatment.
CONCLUSION: Treatment with divalproex sodium may be more effective than placebo for global symptomatology, level of functioning, aggression, and depression. Controlled trials with larger sample sizes are warranted to confirm these preliminary results.

Divalproex sodium (anticonvulsant)
Hollander E, Swann AC, Coccaro EF,... - Department of Psychiatry, Mount Sinai School of Medicine, New York, USA
Am J Psychiatry. 2OO5 - Impact of trait impulsivity and state aggression on divalproex versus placebo response in borderline personality disorder
Fifty-two outpatients with DSM-IV borderline personality disorder were randomly assigned to receive divalproex (N=20) or placebo (N=32), double-blind, for 12 weeks.
Results: Divalproex was superior to placebo in reducing impulsive aggression in patients with borderline personality disorder. Divalproex-treated patients responded better than placebotreated patients among those with higher baseline trait impulsivity symptoms and state aggression symptoms.

 

• Fluoxetine(ssri) / Olanzapine(atypical neuroleptic)

Zanarini MC, Frankenburg FR, Parachini EA. - Laboratory for the Study of Adult Development, McLean Hospital, Belmont USA.
J Clin Psychiatry. 2OO4 Jul - A preliminary, randomized trial of fluoxetine, olanzapine, and the olanzapinefluoxetine combination in women with borderline personality disorder.
BACKGROUND: The intent of this study was to compare the efficacy and safety of fluoxetine, olanzapine, or the olanzapine-fluoxetine combination (OFC) in the treatment of women meeting criteria for borderline personality disorder (without concurrent major depressive disorder).
RESULTS: Fourteen subjects were randomized to fluoxetine; 16, to olanzapine; and 15, to OFC. Forty-two of these subjects (93.3%) completed all 8 weeks of the trial.
CONCLUSION: All 3 compounds studied appear to be safe and effective agents in the treatment of women with borderline personality disorder, significantly ameliorating the chronic dysphoria and impulsive aggression common among borderline patients.
However, olanzapine monotherapy and OFC seem to be superior to fluoxetine monotherapy in treating both of these dimensions of borderline psychopathology.

Fluoxetine(ssri)
Silva H, Jerez S, Paredes A, Salvo J,... - Dept. de Psiquiatria y Salud Mental, Facultad de Medicina, Universidad de Chile.
Actas Luso Esp Neurol Psiquiatr Cienc Afines. 1997 - "Fluoxetine in the treatment of borderline personality disorder"
OBJECTIVE: This study evaluates the therapeutic effect of fluoxetine, a selective serotonin reuptake inhibitor, in borderline personality disorder.
RESULTS: There were significant improvements in BPRS, HDRS, GAF and Impulsivity Scale from the first week of the treatment. These improvements continued until the seven week of treatment. The favourable outcome was not only due to the improvement in depression and impulsivity scores, but also to the decline of global psychopathology.
CONCLUSIONS: The data suggest that fluoxetine is an effective pharmacologic treatment for borderline personality disorder. These findings support the hypothesis of a 5-HT dysfunction in borderline personality disorder.

Fluoxetine(ssri)
Salzman C, Wolfson AN, Schatzberg A, Looper J,... - Dept. of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center, Boston, USA.
J Clin Psychopharmacol. 1995 Feb - "Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder."
...This article describes the results of a 13-week double-blind study of volunteer subjects with mild to moderately severe borderline personality disorder...
These data support previous observations that fluoxetine may reduce anger in patients with borderline personality disorder. The number of subjects in this study was small, the placebo responsiveness was high, and the clinical characteristics of the patients were in the mild to moderate range of severity...
 

• Fluvoxamine(SSRI)

Rinne T, van den Brink W, Wouters L, van Dyck R. - Dept. of Psychiatry, Leiden University Medical Center, The Netherlands.
Am J Psychiatry. 2OO2 Dec - "SSRI treatment of borderline personality disorder: a randomized, placebocontrolled
clinical trial for female patients with borderline personality disorder."
METHOD: A double-blind, placebocontrolled, randomized trial using the SSRI fluvoxamine for 6 weeks followed by a blind half-crossover for 6 weeks and an open follow-up for another 12 weeks was conducted with 38 nonschizophrenic, nonbipolar
female patients with borderline personality disorder.
CONCLUSIONS: In this study, fluvoxamine significantly improved rapid mood shifts in female borderline patients, but not impulsivity and aggression.

Fluvoxamine(SSRI)
Rinne T, de Kloet ER, Wouters L, Goekoop JG,... - Leiden University Medical Center, Department of Psychiatry, Netherlands
Neuropsychopharmacology. 2OO3 Jan - "Fluvoxamine reduces responsiveness of HPA axis in adult female BPD patients with a history of sustained childhood abuse."
The aim of the study is to test whether fluvoxamine affects the function of the hypothalamic pituitary adrenal (HPA) axis in female borderline (borderline personality disorder, BPD) patients with and without a history of sustained childhood abuse. Special attention is given to the presence of comorbid major depressive disorder (MDD) and post-traumatic stress disorder (PTSD).
In conclusion, Fluvoxamine treatment reduces the hyperresponsiveness of the HPA axis in BPD patients with a history of
sustained childhood abuse. This effect is likely to be obtained in the first 6 weeks of treatment.
 

• Haloperidol (neuroleptic) / Phenelzine (imao)

Cornelius JR, Soloff PH, Perel JM, Ulrich RF. - Dept. of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA.
Am J Psychiatry. 1993 Dec - Continuation pharmacotherapy of borderline personality disorder with haloperidol and phenelzine.
OBJECTIVE: The aim of this study was to assess the effectiveness of low-dose neuroleptic medication and monoamine oxidase inhibitor (MAOI) antidepressant medication in continuation pharmacotherapy of patients with borderline personality disorder.
RESULTS: Continuing haloperidol demonstrated efficacy only for the treatment of irritability. Higher levels of depression, hypersomnia, and leaden paralysis were noted in the patients who received haloperidol than in those who received phenelzine and those who received placebo. The dropout rate during the first 8 weeks of the continuation study was significantly higher for the patients receiving haloperidol (64%) than for those receiving placebo (28%). Continued phenelzine demonstrated only modest efficacy for the treatment of depression and irritability.
CONCLUSIONS: No evidence of efficacy was found for continuation therapy with haloperidol in the treatment of borderline personality disorder other than in the treatment of irritability. Little evidence of efficacy was found for continuation therapy with phenelzine for borderline personality disorder other than modest improvements in irritability and depressive symptoms. There is
currently no clear pharmacological treatment of choice for the continuation therapy of borderline personality disorder.

Haloperidol (neuroleptic)
Soloff PH, Cornelius J, George A, Nathan S,... - Department of Psychiatry, University of Pittsburgh, Pa.
Arch Gen Psychiatry. 1993 May - Efficacy of phenelzine and haloperidol in borderline personality disorder.
PATIENTS: One hundred eight consecutively admitted borderline inpatients defined by Gunderson's Diagnostic Interview for Borderline Patients and DSM-III-R criteria, randomly assigned to 38 phenelzine, 36 haloperidol, and 34 placebo trials.
RESULTS: Three-way comparisons between groups indicated superior efficacy for phenelzine, followed by placebo and haloperidol on measures of depression, borderline psychopathologic symptoms, and anxiety. Pairwise comparisons between medication and placebo revealed significant efficacy for phenelzine against anger and hostility but no efficacy against atypical depression or hysteroid dysphoria. We were unable to replicate prior reports of efficacy for the neuroleptic.

Haloperidol (neuroleptic) / Amitriptyline (Antidepressant Tricyclic)
Soloff PH, George A, Nathan S, Schulz PM,... - Western Psychiatric Institute and Clinic, University of Pittsburgh, Pennsylvania.
J Clin Psychopharmacol. 1989 Aug - Amitriptyline versus haloperidol in borderline: final outcomes and predictors of response.
The authors report the final results of a 4-year study of amitriptyline and haloperidol in 90 symptomatic borderline inpatients. Haloperidol produced significant improvement over placebo in global functioning, depression, hostility, schizotypal symptoms, and impulsive behavior.
Significant effects of amitriptyline were generally limited to measures of depression.

Haloperidol (neuroleptic) / Amitriptyline (Antidepressant Tricyclic)
Arch Gen Psychiatry 1986 Jul - Progress in pharmacotherapy of borderline disorders. A double-blind study of amitriptyline, haloperidol, and placebo.
In symptomatic patients with borderline disorder, we conducted a double-blind, placebo-controlled trial of haloperidol and amitriptyline hydrochloride to test the differential efficacy of medication against the affective and schizotypal symptoms that characterize the disorder.
Haloperidol was superior to both amitriptyline and placebo on a composite measure of overall symptom severity, with no difference between amitriptyline and placebo.
Haloperidol produced significant improvement on a broad spectrum of symptom patterns, including depression, anxiety, hostility, paranoid ideation, and psychoticism. In contrast, amitriptyline was minimally effective, with small gains limited to some areas of depressive content.
 

• Olanzapine(atypical neuroleptic) / Fluoxetine(ssri)

Zanarini MC, Frankenburg FR, Parachini EA. - Laboratory for the Study of Adult Development, McLean Hospital, Belmont USA.
J Clin Psychiatry. 2OO4 Jul - A preliminary, randomized trial of fluoxetine, olanzapine, and the olanzapinefluoxetine combination in women with borderline personality disorder.
BACKGROUND: The intent of this study was to compare the efficacy and safety of fluoxetine, olanzapine, or the olanzapine-fluoxetine combination (OFC) in the treatment of women meeting criteria for borderline personality disorder (without concurrent major depressive disorder).
RESULTS: Fourteen subjects were randomized to fluoxetine; 16, to olanzapine; and 15, to OFC. Forty-two of these subjects (93.3%) completed all 8 weeks of the trial.
CONCLUSION: All 3 compounds studied appear to be safe and effective agents in the treatment of women with borderline personality disorder, significantly ameliorating the chronic dysphoria and impulsive aggression common among borderline patients.
However, olanzapine monotherapy and OFC seem to be superior to fluoxetine monotherapy in treating both of these dimensions of borderline psychopathology.

Olanzapine(atypical neuroleptic)
Bogenschutz MP, George Nurnberg H. - Dept of Psychiatry, University of New Mexico School of Medicine, Albuquerque, USA.
2OO4 J Clin Psychiatry. - Olanzapine versus placebo in the treatment of borderline personality disorder.
Atypical antipsychotics are increasingly used in clinical practice in the management of borderline personality disorder (BPD), and a small but growing body of literature supports their efficacy. Here, we report the results of a double-blind, placebo-controlled study of olanzapine as a treatment for BPD.
CONCLUSIONS: This study supports the efficacy of olanzapine for symptoms of BPD in a mixed sample of women and men...

Olanzapine(atypical neuroleptic)
Zanarini MC, Frankenburg FR. - McLean Hospital, Belmont, USA.
2OO1 J Clin Psychiatry. 2OO1 - Olanzapine treatment of female borderline personality disorder patients: a doubleblind,
placebo-controlled pilot study.
BACKGROUND: The intent of this study was to compare the efficacy and safety of olanzapine versus
placebo in the treatment of women meeting criteria for borderline personality disorder (BPD).
CONCLUSION: Olanzapine appears to be a safe and effective agent in the treatment of women with criteria-defined BPD, significantly affecting all 4 core areas of borderline psychopathology (i.e., affect, cognition, impulsivity, and interpersonal
relationships).

Olanzapine(atypical neuroleptic)
Schulz SC, Camlin KL, Berry SA, ... - Dept. of Psychiatry, University of Minnesota Medical School, Minneapolis, USA.
Biol Psychiatry. 1999 Nov - Olanzapine safety and efficacy in patients with borderline personality disorder and comorbid dysthymia.
BACKGROUND: Numerous medications have been tested in patients with borderline personality disorder (BPD) and/or schizotypal personality disorder (SPD). Although many of the medications tested have been demonstrated to be useful, no clear main treatment for BPD has emerged.
Patients suffering from BPD and dysthymia were included in an 8-week, open-label study of olanzapine monotherapy.
Within the global ratings, symptoms of psychoticism, depression, interpersonal sensitivity, and anger were among the symptoms to be reduced. No movement disorder symptoms were noted for any of the patients.
CONCLUSIONS: In this open-label pilot study, patients treated with olanzapine showed statistically significant reduction in self-rated and clinician-rated scales. Symptoms associated with BPD and dysthymia were among those to be substantially reduced.
 

• Oxcarbazepine (anticonvulsants)

Bellino S, Paradiso E, Bogetto F. - Unit of Psychiatry, Department of Neuroscience, University of Turin, Italy
J Clin Psychiatry. 2OO5 Sep - Oxcarbazepine in the treatment of borderline personality disorder
BACKGROUND: According to available studies concerning treatment of patients with borderline personality disorder, mood stabilizers have been found effective in controlling core symptoms of borderline pathology, in particular impulsive behavior and mood instability...
METHOD: Seventeen outpatients diagnosed with DSM-IV-TR borderline personality disorder were included...
RESULTS: Four patients discontinued treatment in the first 4 weeks due to noncompliance. A statistically significant response to oxcarbazepine was observed... including interpersonal relationships, impulsivity, affective instability, and outbursts of anger. No cases of significant hyponatremia or severe adverse effects were reported. Mild to moderate adverse effects included sedation, dizziness, nausea, and headache. Seven patients reported no adverse effects. CONCLUSION: Oxcarbazepine was found an effective and well-tolerated treatment in the management of borderline personality disorder patients.

• Quetiapine(atypical neuroleptic)

Hilger E, Barnas C, Kasper S. - Dept. of General Psychiatry, University of Vienna, Austria.
World J Biol Psychiatry. 2OO3 Jan - Quetiapine in the treatment of borderline personality disorder.
Affective dysregulation, impulsivity and cognitive-perceptual difficulties are the psychopathological nuclear dimensions of Borderline Personality Disorder (BPD).
Preliminary data reveal efficacy of atypical antipsychotics in BPD. We describe the impact of the novel antipsychotic drug quetiapine on severe selfmutilation in two female patients with the diagnoses of BPD. In both cases, monotherapeutic treatment with quetiapine was well tolerated and resulted in a marked improvement of impulsive behaviour and, over time, overall level of function. Though promising, our findings have to be regarded as preliminary... Thus, there is a clear need for further controlled studies to evaluate pharmacological treatment options for this disorder.
 
• Quetiapine(atypical neuroleptic)

Villeneuve E, Lemelin S. - Clinique Le Faubourg St-Jean (Centre hospitalier Robert-Giffard), Quebec, Canada.
J Clin Psychiatry. 2OO5 Oct - Open-label study of atypical neuroleptic quetiapine for treatment of borderline personality disorder: impulsivity as main target.
Recent studies indicate that atypical neuroleptics may be safe and useful in treating many symptoms of borderline personality disorder (BPD), including impulsivity, which can constitute the core dimension of this pathology. This study aimed to evaluate the efficacy and safety of quetiapine in patients with well-defined BPD.
METHOD: Twenty-three outpatients with BPD according to DSM-IV criteria and the revised Diagnostic Interview for Borderlines completed a 12-week open-label study with quetiapine
RESULTS: Impulsivity was significantly improved by quetiapine, as were most of our outcome measures: hostility, depression, anxiety, character dimensions, and social and global functioning .
CONCLUSION: In a sample of patients with severe BPD without or with only few psychotic symptoms, a low dose of quetiapine was associated with a strong positive clinical impact, including improvement of impulsivity.
 
• Risperidone(atypical neuroleptic)

Rocca P, Marchiaro L, Cocuzza E, Bogetto F. - Department of Neuroscience, University of Turin, Italy
J Clin Psychiatry. 2OO2 Mar - Treatment of borderline personality disorder with risperidone.
BACKGROUND: ... Possible targets for pharmacotherapy are affective symptoms, cognitive disturbances, and
impulsive, self-injurious behaviors.
RESULTS: There was a significant (p = .0057) reduction in aggression based on Aggression Questionnaire scores. This amelioration was coupled with an overall improvement, including a reduction in depressive symptoms and an increase in energy and global functioning.
CONCLUSION: Risperidone at low-to-moderate doses can improve BPD symptomatology.

Risperidone(atypical neuroleptic)
Khousam HR, Donnelly NJ. - Dept. of Psychiatry, Manchester Veterans Affairs Medical Center, New Hampshire
J New Ment Dis 1997 - Remission of self-mutilation in a patient with borderline personality during risperidone therapy.

Risperidone(atypical neuroleptic)
José Blaya Perez Filho, Liane Blaya, Carolina Blaya,... -
revista de psiquiatria clinica JULY/AUGUST  1999 - "Remission of self-injurious behavior in patients with borderline personality disorder during risperidone therapy _ Report of three cases"
...The aim of this study is to report three cases in which risperidone treatment led to the remission of self-mutilation. This remission was complete in all patients.
 

• Sertraline (SSRI) / Citalopram (SSRI)

Ekselius L, von Knorring L. - Dept. of Neuroscience, Psychiatry, University Hospital, Uppsala, Sweden.
Int Clin Psychopharmacol. 1998 Sep - "Personality disorder comorbidity with major depression and response to treatment
with sertraline or citalopram."
A total of 308 patients with a major depressive disorder were assessed..., before and after 24 weeks double-blind treatment with sertraline (50-150 mg/day) or citalopram (20-60 mg/day).
Following treatment, significant reductions in the frequency of paranoid, borderline, avoidant and dependent personality disorder diagnoses were seen in both treatment groups.
When the personality disorders were analysed as continuous, dimensional personality traits significant
reductions were seen for most personality categories.
The results suggest that sertraline and citalopram may be beneficial in the treatment of certain personality disorder traits in patients with major depressive disorders.
 
• Topiramate (anticonvulsants)

Loew TH, Nickel MK, Muehlbacher M,... - Dept. of Psychosomatic Medicine, University Clinic, Regensburg, Germany...
J Clin Psychopharmacol. 2OO6 Feb - "Topiramate Treatment for Women With Borderline Personality Disorder: A Double-blind, Placebo-Controlled Study"
... The goal of this study was to determine whether topiramate can influence patients' borderline psychopathology, health-related quality of life, and interpersonal problems. Women meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Structured Clinical Interview II criteria for borderline personality disorder were randomly assigned to topiramate or placebo for 10 weeks... According to the intent-to-treat principle, significant changes (all P < 0.001) on the somatization, interpersonal sensitivity, anxiety, hostility, phobic anxiety, and Global Severity Index scales of the Symptom Checklist were observed in the topiramate-treated subjects after 10 weeks...
Weight loss was additionally observed (p < 0.001). Topiramate appears to be a safe and effective agent in the treatment in women with borderline personality disorder. Additional weight loss can be expected
 
• Tranylcypromine (IMAO) / Alprazolam / carbamazepine and trifluoperazine

Cowdry RW, Gardner DL. - Intramural Research Program, National Institute of Mental Health, Bethesda
Arch Gen Psychiatry. 1988 - Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine.
Physicians rated patients as significantly improved relative to placebo while receiving tranylcypromine and carbamazepine. Patients rated themselves as significantly improved relative to placebo only while receiving tranylcypromine. Patients who tolerated a full trial of trifluoperazine showed improvement, those receiving carbamazepine demonstrated a marked decrease in the severity of behavioral dyscontrol, and those receiving alprazolam had an increase in the severity of the episodes of serious dyscontrol
 
• Valproate (anticonvulsants)

Stein DJ, Simeon D, Frenkel M, Islam MN,... - Dept. of Psychiatry, University of Stellenbosch, Tygerberg, South Africa.
J Clin Psychiatry. 1995 Nov - An open trial of valproate in borderline personality disorder.
BACKGROUND: Target symptoms in pharmacotherapy of borderline personality disorder include mood
instability, anxiety, and impulsivity.
METHOD: Eleven patients who met DSM-III-R criteria for borderline personality disorder were entered into an 8-week study of valproate...
CONCLUSION: Valproate led to overall improvement in 50% of a small sample of borderline personality disorder patients who completed an 8-week open trial. The medication was modestly helpful for mood and irritability as well as for anxiety, anger, rejection sensitivity, and impulsivity, but specific therapeutic effects varied from patient to patient. More extensive
controlled trials of anticonvulsants for impulsive personality disorders are warranted.
 
• Venlafaxine(SSRI, SNRI)

Markovitz PJ, Wagner SC. -
Psychopharmacol Bull. 1995 - "Venlafaxine in the treatment of borderline personality disorder."
A number of studies have indicated that selective serotonin reuptake inhibitors (SSRIs) are effective in
reducing the symptomatology accompanying borderline personality disorder (BPD). The SSRIs have
proven efficacious in reducing self-injury, suicidality, affective instability, rage, impulsivity, psychosis, and
obsessionality. Fluoxetine and sertraline have been shown to be effective in clinical trials, although no
single SSRI has emerged as the treatment of choice. Individuals failing one SSRI often respond to another.
The data presented in this article indicate that venlafaxine is effective in treating borderline personality
disorder (BPD) as an initial intervention and may benefit many individuals for whom fluoxetine or sertraline treatment has failed.

Venlafaxine(SSRI, SNRI)
Hirschfeld RM. - Dept. of Psychiatry & Behavioral Sciences, University of Texas Medical Branch, Galveston , USA.
J Clin Psychiatry. 1997 - Pharmacotherapy of borderline personality disorder.
Borderline personality disorder can be classified into four groups of symptoms: affective, impulsive, egointerpersonal,
and psychotic. This article reviews the pharmacotherapy of borderline personality disorder, with special emphasis on affective and impulsive symptoms. Overall, the MAOIs, the SSRIs, and the newer antidepressants (such as venlafaxine) provide the widest spectrum of effective treatment for the symptoms of borderline personality disorder.
 

• Ziprasidone (atypical neuroleptic)

Pascual JC, Oller S, Soler J,... -
J Clin Psychiatry. 2OO4 - Ziprasidone in the acute treatment of borderline personality disorder in psychiatric emergency services.
Twelve borderline personality disorder patients (diagnosed with the Structured Clinical Interview for DSM-IV
Axis II Disorders... and were included in a 2-week open-label study... Nine patients (75%) completed the trial.
Results from this open-label, uncontrolled study suggest ziprasidone may be effective, fast, and safe for treating acutely ill borderline personality disorder patients.