Fluvoxamine reduces responsiveness of HPA axis in adult female BPD patients with a history of sustained childhood abuse

Abstract

The aim of the study is to test whether fluvoxamine affects the function of the hypothalamic pituitary adrenal(HPA) axis in female borderline (borderline personality disorder, BPD) patients with and without a history of sustained childhood abuse. Specialattention isgiven to the presence of comorbid major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The HPA axis of 30female BPD patients with (n = 17) and without (n = 13) a history of sustained childhood abuse was challenged with a combineddexamethasone and corticotropin releasing hormone test (DEX/CRH test) before and after 6 (n = 14) and 12 (n = 16) weeks offluvoxamine treatment (150mg/day). Both 6- and 12-week fluvoxamine treatments were associated with a significant and robustreduction of the adrenocorticotrophic hormone (ACTH) and cortisolresponse to the DEX/CRH test. The magnitude of the reductionwas dependent on the presence of sustained childhood abuse, but not on the presence of comorbid MDD or PTSD: patients with ahistory of sustained childhood abuse showed the strongest reduction in ACTH and cortisol. In conclusion, Fluvoxamine treatmentreduces the hyperresponsiveness of the HPA axis in BPD patients with a history of sustained childhood abuse. This effect is likely to beobtained in the first 6 weeks of treatment. © 2003 American College of Neuropsychopharmacology.