A Systematic Review on Pharmacological Interventions in Borderline Personality Disorder: Efficacy, Safety, and Management Challenges

Abstract

Background: Borderline Personality Disorder (BPD) is a complex psychiatric condition characterized by emotional instability, impulsivity, and interpersonal difficulties. Pharmacotherapy is commonly used in addition to psychotherapy to manage specific symptom domains of BPD. This systematic review aims to evaluate the safety and efficacy of pharmacological interventions in BPD. Methods: A systematic literature search was conducted using Ovid Medline. The initial search identified 1,689 papers, which were screened based on relevance to the topic, resulting in 12 studies that met the inclusion criteria. The final 12 articles were grouped into three overarching themes: the efficacy of antipsychotics, the effectiveness of non-antipsychotic treatments, and challenges in pharmacological management. Results: The review revealed mixed outcomes for pharmacotherapy in BPD. Antipsychotics showed some efficacy in reducing emotional dysregulation and impulsivity, though side effects were noted. Non-antipsychotic treatments, including lamotrigine, showed limited efficacy, while ketamine showed potential effectiveness for refractory cases. Challenges in pharmacological management were prominent. Discussion: Pharmacotherapy can play a role in symptom management for BPD, especially for severe cases unresponsive to psychotherapy alone. However, the evidence remains inconsistent, and no medication has demonstrated comprehensive efficacy across all symptom domains. Conclusion: Pharmacological interventions for BPD offer symptom relief for certain patients, particularly with antipsychotics. However, due to the inconsistent evidence and concerns about long-term safety, pharmacotherapy should be carefully individualized and combined with psychotherapy.