SAN FRANCISCO -- Trials of drug therapy for borderline personality disorder have produced conflicting results and controversy, but a new trend is emerging: targeting medications to syndromes within the diagnosis.
Two or three recent meta-analyses of studies provide some support for this strategy, Dr. S. Charles Schulz said at the meeting, where he led an interest group discussion on drug therapy for borderline personality disorder.
"For the impulsive-aggressive borderline patients, the mood-stabilizing anticonvulsants have a very significant effect. For anger and cognitive or perceptual disturbance, the atypical antipsychotics are pretty good. For some depressed patients" with borderline personality disorder, the selective serotonin reuptake inhibitors (SSRIs) "can be useful," though they have a small effect in these patients, said Dr. Schulz, chair of psychiatry at the University of Minnesota, Minneapolis.
As a result, in the last 4 years or so, clinicians are thinking more in terms of targeting medications to subsets of patients rather than drug therapy for borderline personality disorder as a whole, he said. "That's emerging" and is a strategy worth testing in prospective trials, Dr. Schulz said. The scant data in the meta-analyses are "nowhere near enough to fully support what these meta-analyses" suggest, he added.
No medications have been approved by the Food and Drug Administration to treat borderline personality disorder.
Research also is needed to build on preliminary studies of combining drug therapy with psychosocial therapy for borderline personality disorder, he said. One preliminary study found that people with borderline personality disorder who were randomized to dialectical behavior therapy (DBT) plus the atypical antipsychotic olanzapine showed significantly more improvement than did patients who got DBT plus placebo. "The strongest impact was on decreased danger," he said.
Studies of combining medications and psychosocial therapies are much more common for other psychiatric diagnoses than for borderline personality disorder, Dr. Schulz noted. "I would really like for us to step it up and mirror some of the other studies done for schizophrenia and bipolar disorder," he said.
He believes the National Institute of Mental Health should better fund large studies of drug therapy for borderline personality disorder, as it has for other diagnoses.
"I feel pretty passionately about this," Dr. Schulz said in an interview after the group discussion. …