Fluvoxamine Helpful in Women With Borderline Personality Disorder

Jan. 3, 2003 — The selective serotonin reuptake inhibitor (SSRI) fluvoxamine improved rapid mood shifts in women with borderline personality disorder but did not improve impulsivity and aggression, according to the results of a double-blind, placebo-controlled, randomized trial reported in the December issue of the American Journal of Psychiatry.

"SSRIs are recommended for treatment of affect lability, impulsivity, and aggression in patients with borderline personality disorder," write Thomas Rinne, MD, PhD, from the University of Leiden in the Netherlands, and colleagues. "A randomized, placebo-controlled SSRI study with borderline personality disorder patients, however, provided inconclusive results because of a large response to placebo."

Although SSRIs are used to treat lability, impulsivity, and aggression in people with borderline personality disorder, this study challenges the theory that targeting the central serotonergic system might improve these behaviors and raises questions about the benefits of these drugs in this population.

In this study, 38 nonschizophrenic, nonbipolar female patients with borderline personality disorder received fluvoxamine or placebo for six weeks followed by a blind half-crossover for six weeks and an open follow-up for another 12 weeks.

Based on the Borderline Personality Disorder Severity Index, fluvoxamine but not placebo produced a significant and long-lasting reduction in the rapid mood shift subscale score. However, impulsivity and aggression subscale scores were similar in both groups.

"The present study addresses a major problem for evidence-based medicine and the pharmacological treatment of borderline patients," the authors write. "Fluvoxamine significantly improved rapid mood shifts in female borderline patients, but not impulsivity and aggression. This latter finding may be due to gender-specific differences."

The investigators recommend additional randomized, double-blind, placebo-controlled studies of larger numbers of both men and women with borderline personality disorder, and more sophisticated research strategies to address the large placebo effect in borderline personality disorder and high dropout rates in especially impulsive subjects.

"Our study provides at least some support for SSRI treatment of rapid mood shifts in female borderline patients," they write. "The scientific discussion of the role of SSRIs in the treatment of borderline pathology is therefore far from closed.... These data challenge the serotonin hypothesis with respect to impulsive aggressive behavior in women."

Am J Psychiatry. 2002;159(12):2048-2054

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