The Pharmacotherapy of Borderline Personality Disorder

Pharmacotherapy is used increasingly as a helpful adjunct to psychotherapeutic interventions in the treatment of borderline personality disorder. Clinical trials have been performed to investigate drug treatment of the 3 symptom clusters associated with borderline personality disorder — impulsivity, affective lability and psychotic-like symptoms. Although no single agent ameliorates all the symptoms of this diagnosis, and patients vary considerably in their response to medication, pharmacological strategies for each symptom can be delineated. Impulsivity and aggression can be treated with selective serotonin (5-hydroxy-tryptamine; 5-HT) reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), lithium, β-adrenoceptor blockers or antipsychotics. Affective symptomology has also been found to respond to MAOIs, SSRIs and lithium. Interestingly, patients with borderline personality disorder do not seem to respond to tricyclic antidepressants. As would be expected, antipsychotics are the most effective medications for the treatment of the psychotic symptoms of borderline personality disorder. Various techniques to improve compliance and enhance the treatment alliance with the patient can be suggested, including patient education about the role of the pharmacologist (and therapist) in treatment and about the nature of agents prescribed. In addition, if possible, patients should be allowed to play an active part in the selection of drugs.