Psychopharmacological Treatments for Emotion Dysregulation in Borderline Personality Disorder

Affective instability

Most studies did not look at affective instability as a separate measure. Due to lack of direct measurement, only a meta-analysis of studies on olanzepine was performed. Olanzepine showed a small improvement in affective instability when compared with the placebo, based on a meta-analysis of three RCTs (n=631). One study did not find a difference in effect on affective instability between olanzepine and placebo. Olanzepine treatment was accompanied by significant side effects compared to the placebo: weight gain, increased appetite, somnolence, mouth dryness, changes in liver transaminases, altered lipid profile, increase in prolactin, changes in blood cell count, and decrease in blood calcium.

Abstract

The drug treatment of affective symptoms in borderline personality disorder (BPD) has been the subject of four recent meta-analyses of randomized controlled studies (RCTs). This paper reviews the current evidence-based recommendations for the psychopharmacological treatment of the affective symptoms in BPD: affective instability, anger, depression, and anxiety. There was not enough data on affective instability as an outcome measure to make a good conclusion. Most of the evidence point to a large reduction of anger with mood stabilizers and antipsychotics. Mood stabilizers are also moderately effective against depressed mood and anxiety. Contrary to prior guidelines, selective serotonin reuptake inhibitors (SSRIs) were shown to be minimally effective against depression in BPD. Omega 3 fatty acids helped reduce depression. These results suggest that clinicians should raise their threshold for prescribing medication for affective instability, anxiety, and depression, but not for anger. Clinicians must also weigh the benefits of medication over their side effects in the neurologic and metabolic domains. The meta-analyses were limited by the heterogeneity in methodology, by the small number of RCTs for each drug and small sample sizes, and by the exclusion of patients with comorbidities that are common in this population.

Keywords

borderline personality disorder, affective instability, emotion dysregulation, anger, anxiety, depression, drug therapy, evidence based practice