Pharmacology

Abstract

This chapter reviews the pharmacologic treatment of mood symptoms in borderline personality disorder (BPD). There needs to be a determination as to what are the specific mood symptom complaints. The use of the word “depression” by the patient does not mean that the patient is in a major depressive episode (MDE). MDE needs to be distinguished from the chronic dysphoria, loneliness, and emptiness that patients with BPD frequently experience. Emotion dysregulation needs to be distinguished from the mood swings attendant to bipolar disorder. There have been trends in the pharmacologic treatment of BPD that follow the overall trends in the psychopharmacology of psychiatric disorders in general, i.e., the SSRIs during the late 1980s through the 1990s shifting into mood stabilizers and atypical antipsychotics after the turn of the century. There is little good evidence for the treatment of depression in BPD except for the use of antidepressants when there is a bona fide comorbid MDE. There is a current trend for the use of either mood stabilizers or antipsychotics for emotion dysregulation, though evidence remains weak and frequently contradictory when examining systematic and Cochrane reviews of pharmacologic treatment in BPD. Psychopharmacologic treatment remains adjunctive to psychotherapy, and this knowledge can help restrain the psychopharmacologist from pharmacologic overenthusiasm and polypharmacy, neither of which has any evidence for effectiveness in BPD.