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  • Title: [Drug therapy of patients with emotionally unstable personality].
    Author: Nissen T.
    Journal: Tidsskr Nor Laegeforen; 2000 Aug 10; 120(18):2135-41. PubMed ID: 11006733.
    Abstract:
    BACKGROUND: Most patients with borderline personality disorders are treated with psychotropic medication. There are, however, no clear clinical guidelines concerning optimal treatment of the disorder. MATERIAL AND METHODS: This article reviews the data on the efficacy of treatment with different classes of psychopharmacological drugs. The emphasis is on clinical trials published after 1981, as most placebo-controlled double-blind studies have been done in the last two decades. Furthermore, studies conducted before 1980 are more difficult to interpret because of changes in clinical diagnostic criteria. RESULTS: Neuroleptics have been studied most extensively followed by antidepressants. Neuroleptics have a modest, but broad therapeutic effect on symptoms in all domains. Doses are lower than those used for treating schizophrenia. Antidepressants have a more inconsistent effect. Tricyclics have been the least successful, whereas irreversible MAO inhibitors and selective serotonin reuptake inhibitors (SSRIs) have been effective in treating mood symptoms and impulsivity. Lithium has a possible effect in diminishing anger and suicidal symptoms. INTERPRETATION: As there is no "drug of choice" for the treatment of borderline personality disorder, a more rational clinical approach might be to treat different symptom clusters (cognitive/schizotypal, affective, impulsive) rather than the disorder itself. Finally, some practical guidelines for drug treatment of the disorder are proposed.
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