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Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials.

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Klaus Lieb, Birgit Völlm, Gerta Rücker, Antje Timmer, Jutta M. StoffersThe British Journal of Psychiatry Dec 2009, 196 (1) 4-12; DOI: 10.1192/bjp.bp.108.062984
Twenty-seven trials were included in which first- and second-generation antipsychotics, mood stabilisers, antidepressants and omega-3 fatty acids were tested. Most beneficial effects were found for the mood stabilisers topiramate, lamotrigine and valproate semisodium, and the second-generation antipsychotics aripiprazole and olanzapine. However, the robustness of findings is low, since they are based mostly on single, small studies. Selective serotonin reuptake inhibitors so far lack high-level evidence of effectiveness. The current evidence from randomised controlled trials suggests that drug treatment, especially with mood stabilisers and second-generation antipsychotics, may be effective for treating a number of core symptoms and associated psychopathology, but the evidence does not currently support effectiveness for overall severity of borderline personality disorder. There is some evidence that olanzapine may increase self-harming behaviour. Pharmacotherapy should therefore be targeted at specific symptoms. 

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