Borderline Personality Disorder: Bipolarity, Mood Stabilizers and Atypical Antipsychotics in Treatment

Many psychiatrists have reconceptualized borderline personality disorder (BPD) as a variant of bipolar disorder and, consistent with the treatment of bipolar disorder, emphasize the use of mood stabilizers and atypical antipsychotics in treatment. This change in diagnostic practice is unfortunate. BPD is a distinct diagnostic construct, and clients who fit this pattern require a fundamentally different treatment approach than what is typically recommended for bipolar disorder. The purpose of this article is to update counselors on the expansion of bipolar disorder in the psychiatric literature, present evidence for the validity of BPD, discuss strategies for the differential diagnosis of it from bipolar disorder, review proposed changes in DSM-V, and integrate the literature into a mental health counseling framework.

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Pharmacotherapy of borderline personality disorder: what has changed over two decades? A retrospective evaluation of clinical practice

BMC Psychiatry ◽

10.1186/s12888-019-2377-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 4

Author(s):

Charles Timäus ◽

Miriam Meiser ◽

Borwin Bandelow ◽

Kirsten R. Engel ◽

Anne M. Paschke ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Psychotropic Drug ◽

Inpatient Treatment ◽

Medical Center ◽

Borderline Personality ◽

Mood Stabilizers ◽

Main Diagnosis ◽

Tetracyclic Antidepressants ◽

Prescription Rates

Abstract Background The purpose of this study was to assess the pharmacological treatment strategies of inpatients with borderline personality disorder between 2008 and 2012. Additionally, we compared pharmacotherapy during this period to a previous one (1996 to 2004). Methods Charts of 87 patients with the main diagnosis of borderline personality disorder receiving inpatient treatment in the University Medical Center of Goettingen, Germany, between 2008 and 2012 were evaluated retrospectively. For each inpatient treatment, psychotropic drug therapy including admission and discharge medication was documented. We compared the prescription rates of the interval 2008–2012 with the interval 1996–2004. Results 94% of all inpatients of the interval 2008–2012 were treated with at least one psychotropic drug at time of discharge. All classes of psychotropic drugs were applied. We found high prescription rates of naltrexone (35.6%), quetiapine (19.5%), mirtazapine (18.4%), sertraline (12.6%), and escitalopram (11.5%). Compared to 1996–2004, rates of low-potency antipsychotics, tri−/tetracyclic antidepressants and mood stabilizers significantly decreased while usage of naltrexone significantly increased. Conclusions In inpatient settings, pharmacotherapy is still highly prevalent in the management of BPD. Prescription strategies changed between 1996 and 2012. Quetiapine was preferred, older antidepressants and low-potency antipsychotics were avoided. Opioid antagonists are increasingly used and should be considered for further investigation.

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Do Mood Stabilizers Help in Borderline Personality Disorder?

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.203 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S47-S47

Author(s):

B. Völlm ◽

J. Stoffers-Winterling ◽

J. Mattivi ◽

E. Simonson ◽

O.J. Storebø ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Meta Analysis ◽

Cochrane Review ◽

Evidence Base ◽

Borderline Personality ◽

Mood Stabilizers ◽

Beneficial Effects ◽

Drug Classes ◽

Competing Interest

BackgroundDespite the relatively weak evidence base, individuals with borderline personality disorder are often treated with pharmacological interventions. Amongst the drugs, which have shown most promise, are mood stabilizers, which were one of the two drug classes with the most beneficial effects in a previous cochrane review though the robustness of findings was described as low (Stoffers et al., 2010). Here we present data on the latest evidence for mood stabilizers based on an updated cochrane review currently underway.MethodsA systematic review and meta-analysis of randomized controlled trials was conducted. All randomized comparisons of drug vs. placebo, drug vs. drug, or drug vs. a combination of drugs in adult BPD patients were eligible for inclusion. Outcomes comprised BPD core pathology as depicted by DSM criteria, associated pathology, i.e., depression and anxiety, general measures of overall psychopathology severity, tolerability, and adverse effects. Two researchers selected trials, assessed quality and extracted data independently.ResultsOnly a limited number of additional trials using mood stabilizers was identified since the publication of the last cochrane review, mainly utilizing Sodium Valproate. This added to the evidence base for mood stabilizers though the overall evidence remains very limited.ConclusionMood stabilizers show some initial evidence for their effectiveness in borderline personality disorder. However, these have to be replicated before wider conclusions can be drawn for clinical practice.Disclosure of interestThe authors declare that they have no competing interest.

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Meta-Analyses of Mood Stabilizers, Antidepressants and Antipsychotics in the Treatment of Borderline Personality Disorder: Effectiveness for Depression and Anger Symptoms

Journal of Personality Disorders ◽

10.1521/pedi.2009.23.2.156 ◽

2009 ◽

Vol 23 (2) ◽

pp. 156-174 ◽

Cited By ~ 64

Author(s):

Deanna Mercer ◽

Alan B. Douglass ◽

Paul S. Links

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

Mood Stabilizers ◽

Meta Analyses

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Psychopharmacological Treatment of Personality Disorders

10.1093/med:psych/9780199342211.003.0028 ◽

2015 ◽

Author(s):

M. Mercedes Perez-Rodriguez ◽

Larry J. Siever

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Personality Disorders ◽

Borderline Personality ◽

Mood Stabilizers ◽

Omega 3 ◽

Psychopharmacological Treatment ◽

Limited Effectiveness ◽

Second Generation Antipsychotics

Despite the lack of approval by the U.S. Food & Drug Administration, drugs are used widely to treat personality disorders, particularly borderline personality disorder, based on their effects known from clinical trials in other psychiatric disorders (off-label use). The role of medications in personality disorders is limited to moderate effects on some but not all of the symptom domains. There are no medications available that improve the global severity of any personality disorder as a whole. In borderline personality disorder, evidence is strongest for second-generation antipsychotics and mood stabilizers, while dietary supplements like omega-3 fatty acids hold some promise. However, medications have limited effectiveness and are still viewed as adjunctive to other forms of treatment, particularly psychotherapy.

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Role of mood stabilizers in borderline personality disorder (BPD)

Current Psychiatry Reports ◽

10.1007/s11920-007-0007-9 ◽

2007 ◽

Vol 9 (1) ◽

pp. 37-39

Author(s):

Paul S. Links

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

Mood Stabilizers

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Evidenced-based pharmacologic treatment of borderline personality disorder: A shift from SSRIs to anticonvulsants and atypical antipsychotics?

Journal of Affective Disorders ◽

10.1016/j.jad.2008.01.024 ◽

2008 ◽

Vol 111 (1) ◽

pp. 21-30 ◽

Cited By ~ 22

Author(s):

P. Francis Abraham ◽

Joseph R. Calabrese

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Atypical Antipsychotics ◽

Borderline Personality ◽

Pharmacologic Treatment ◽

Evidenced Based

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Prescribing Practices for Patients With Borderline Personality Disorder During Psychiatric Hospitalizations

Journal of Personality Disorders ◽

10.1521/pedi_2019_33_405 ◽

2020 ◽

Vol 34 (6) ◽

pp. 736-749

Author(s):

Magdalena Romanowicz ◽

Kathryn M. Schak ◽

Jennifer L. Vande Voort ◽

Jonathan G. Leung ◽

Beth R. Larrabee ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Incidence Rate Ratio ◽

Psychiatric Hospitalization ◽

Tertiary Care ◽

Borderline Personality ◽

Mood Stabilizers ◽

Prescribing Practices ◽

Psychiatric Hospitalizations ◽

The Mean

This study aimed to understand prescribing practices during acute psychiatric hospitalization in a large cohort of patients (N = 569) with borderline personality disorder (BPD) at a tertiary care psychiatry unit from January 1, 2013, through January 1, 2015. The mean number of hospitalizations per patient was 1.5 (range, 1–7). The odds of being prescribed antidepressants, antipsychotics, mood stabilizers, hypnotics, or anxiolytics were higher at discharge than at admission. The rate of psychotropic prescriptions was also higher at discharge than at admission (incidence rate ratio, 1.9). This pattern was true for the combined psychotropic and nonpsychotropic (“medical”) prescriptions. Further guidelines are needed regarding optimal psychosocial, medical, and psychopharmacological care of patients with BPD during acute psychiatric hospitalizations.

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Psychotropic medication use in hospitalized patients with borderline personality disorder

Mental Health Clinician ◽

10.9740/mhc.2016.03.68 ◽

2016 ◽

Vol 6 (2) ◽

pp. 68-74

Author(s):

Karen E Moeller ◽

Amad Din ◽

Macey Wolfe ◽

Grant Holmes

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Psychotropic Medication ◽

Medication Use ◽

Retrospective Chart Review ◽

Borderline Personality ◽

Hospitalized Patients ◽

Mood Stabilizers ◽

Control Group ◽

Sedative Agents

Abstract Introduction: Use of medications to treat symptoms of borderline personality disorder (BPD) is controversial. The purpose of this study was to describe psychotropic medication use in hospitalized patients with BPD and compare with a control group. Methods: A retrospective chart review was conducted on hospitalized patients aged 18-65 years having a diagnosis of BPD and compared them with a control group of patients with a diagnosis of major depressive disorder (MDD) without a personality disorder. Patients were excluded from the BPD group if other personality disorders were recorded. Charts were reviewed for demographics and psychotropic medication usage both prior to admission and at discharge. Results: This study included 165 patients (85 in BPD; 80 in MDD). Prior to admission and upon discharge, patients in the BPD group were prescribed significantly more psychotropic medications than patients with MDD (3.21 vs 2.10; P < .001 and 2.87 vs 2.35; P < .05, respectively). Patients in the BPD group were significantly more likely to be prescribed antipsychotics, mood stabilizers, and miscellaneous agents compared with the MDD group. On admission, significantly more BPD patients were prescribed multiple sedative agents (37.6% vs 21.3%; P < .05), but because of the discontinuation of sedative agents, this difference was nonsignificant upon discharge. Discussion: This study found increased medication utilization among patients with BPD. Polypharmacy may increase the risk of side effects, drug interactions, and drug toxicity for BPD patients. Clinicians need to carefully evaluate the efficacy and risk of medications prescribed in patients with BPD.

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