2023-11-16 22:00:27
Cochrane review finds no evidence that medications improve symptoms of borderline personality disorder
A recent Cochrane review published in 2022 has concluded that pharmacotherapy does not work better for borderline personality disorder than placebo. The study reviewed 45 randomized controlled trials involving a total of 2,752 patients and found that no medications provided a better result than placebo on any primary endpoint. This finding supports the message in guidelines that no medication improves the core symptoms of borderline personality disorder.
Borderline personality disorder is a psychiatric condition with core symptoms of instability in emotion regulation, self-image, interpersonal relationships, and impulse control. The condition is associated with limitations in psychosocial functioning and a high risk of self-harm and suicide, affecting an estimated 0.7 to 2.7% of the population. While many individuals with this disorder have been diagnosed with other psychiatric conditions, there are currently no medications that have been licensed for the treatment of borderline personality disorder.
The Cochrane review included all (unpublished and published) randomized studies on pharmacotherapy in borderline personality disorder with or without comorbidity, excluding studies on short-term medication use in crisis situations. The findings showed that pharmacotherapy did not provide a better result than placebo on any primary endpoint, with very low certainty evidence. The review also found that all RCTs had a high risk of bias, limiting the certainty of the findings.
The review calls for larger-scale research of better quality in patients with psychiatric comorbidity, as well as more information about safety. The authors suggest that more research is needed in populations such as men, young people, and individuals with other psychiatric disorders to determine the applicability of the findings to clinical practice.
While the Cochrane review does not allow statements about the usefulness of pharmacotherapy in a crisis situation, the authors note that short-term pharmacotherapy can be part of the treatment plan in such situations. However, they emphasize the importance of using the lowest possible dose and for a maximum of one week.
In conclusion, the Cochrane review highlights the lack of evidence supporting the efficacy of pharmacotherapy for borderline personality disorder and emphasizes the need for further research in this area.
Sources:
1 Stoffers-Winterling JM, Storebø OJ, Pereira Ribeiro J, et al. Pharmacological interventions for people with borderline personality disorder. Cochrane Database of Systematic Reviews 2022.
2 Leichsenring F, Heim N, Leweke F, et al. Borderline Personality Disorder: A Review. JAMA 2023.
3 Paton C, Crawford MJ, Bhatti SF, et al. The use of psychotropic medication in patients with emotionally unstable personality disorder under the care of UK mental health services. J Clin Psychiatry 2015.]
#Pharmacotherapy #borderline #personality #disorder #BCFI