Drugs can help symptoms of borderline personality

NEW YORK (Reuters Health) - While there are no drugs that specifically treat borderline personality disorder, some medications can improve certain symptoms of the psychiatric condition, a new research review finds.

Borderline personality disorder, or BPD, is a serious mental illness marked by intense mood swings and difficulty with emotional control, impulsive behavior, problems maintaining personal relationships, and high rates of self-injury and suicidal behavior.

Right now, "talk therapy" is the cornerstone of managing BPD, and no drug is specifically approved for treating the disorder. But in a new analysis of 27 clinical trials, researchers found that certain psychiatric drugs do seem to ease some of the major symptoms of BPD.

Specifically, certain newer antipsychotic drugs used for schizophrenia appeared to improve BPD patients' emotional instability and impulsive behavior. Two drugs -- aripiprazole (Abilify) and olanzapine (Zyprexa) -- showed benefits.

In addition, the review found, medications known as mood stabilizers, often used for bipolar disorder, seemed to aid patients' emotional control and rein in impulsivity. Benefits were seen with the drugs topiramate (Topamax), divalproex sodium (Depakote) and lamotrigine (Lamictal), which are all anti-seizure medications that have mood-stabilizing effects.

"Drugs may be effective in treating certain symptoms of BPD, such as impulsivity and difficulties to control anger," Dr. Klaus Lieb, the lead researcher on the review, noted in an email to Reuters Health.

But medications, if they are used, should be given to target specific symptoms, and not as a treatment for the overall disorder, added Lieb, of the University Medical Center Mainz, in Germany.

The findings, published in the British Journal of Psychiatry, are based on the results of 27 clinical trials, most of which were done in the past decade.

On average, patients randomly assigned to take second-generation antipsychotics or mood stabilizers saw improvements in certain symptoms, compared with patients who were given a placebo.

There was also some promising evidence on omega-3 fatty acid supplements, which in one study were shown to reduce BPD patients' depression symptoms and suicidal behavior by about half.

Some other studies have suggested that omega-3 fats -- found largely in fish oil -- have antidepressant effects, and supplements are being investigated as a treatment for depression and bipolar disorder. The jury is still out on their effectiveness.

For people with borderline personality disorder, talk therapy remains the "first-line" treatment, according to Lieb. What this review suggests, he said, is that certain patients may benefit from drugs that target their particular symptoms.

He added that if a patient does begin a drug, his or her symptoms should be continually monitored, and if there is no improvement after three months, the medication should be stopped.

While antipsychotics and mood stabilizers can be effective, they also carry the risk of side effects -- including, drug dependence, weight gain or weight loss, fatigue, high cholesterol and difficulty with memory and concentration.

SOURCE: British Journal of Psychiatry, January 2010.