Pharmacological interventions for borderline personality disorder.

Systematic review of randomized trials in adults diagnosed with borderline personality disorder using DSM criteria. Most participants were outpatients, some trials enrolled only women or mixed-sex samples, and several studies excluded major comorbid psychiatric disorders such as schizophrenia, bipolar disorder, or substance use disorders.

This review evaluated a broad range of oral pharmacologic treatments for borderline personality disorder rather than a single standardized regimen. Active interventions across randomized trials included second-generation antipsychotics such as olanzapine, aripiprazole, and ziprasidone; mood stabilisers/antiepileptics such as topiramate, lamotrigine, valproate semisodium, divalproex sodium, and carbamazepine; antidepressants such as fluoxetine and fluvoxamine; and omega-3 fatty acids/EPA, generally compared with placebo or another drug over weeks to months.

No medication demonstrated a significant reduction in overall borderline personality disorder severity. Some single trials reported symptom-specific benefits for aripiprazole, olanzapine, topiramate, valproate semisodium, and lamotrigine, but these findings were based on a small and fragile evidence base. Antidepressants generally did not show reliable benefit, while omega-3 fatty acids improved suicidality in one trial. Olanzapine was associated with weight gain and other adverse effects, whereas topiramate was linked to weight loss; polypharmacy is not supported.

The evidence base was small, heterogeneous, and often limited to single trials for a given drug. Many studies were short, used different outcome measures, and excluded common comorbid conditions, which limits generalizability to typical clinical populations. Several reported benefits were not replicated across studies, and adverse-effect data were not uniformly robust.