Background: Borderline personality disorder (BPD) is a distressing disorder that is associated with significant morbidity and mortality. Patients with BPD are often admitted to PICUs where psychotropic drugs are usually prescribed to treat trait or state dependant symptoms.
Aims: To review the evidence base for the efficacy of psychotropic drugs in borderline personality disorder.
Method: Medline and Cochrane search covering the period 1966 to March 2003.
Results: Nineteen RCTs and a large number of case reports, case series and open studies were retrieved. Numerous different treatments have been used, each in a small number of patients. Open studies often report remarkable efficacy that is not reproduced in randomised controlled trials.
Conclusions: The initial placebo response to any drug treatment is high but symptoms invariably return leading to the addition of further psychotropic drugs. Long term gains from drug treatment are likely to be small in the majority of patients. Large pragmatic trials of drug treatments could be co-ordinated through the PICU network.
Declarations of Interest: None.