Evaluation of naltrexone for dissociative symptoms in borderline personality disorder

Abstract

Data from a pilot study suggest that naltrexone might reduce dissociative symptoms in patients with borderline personality disorder. However, the interpretation of these data is limited by the lack of a control group and by the nonblind nature of this study. Hence, we examined the effects of naltrexone using a more rigorous design that controlled for major confounders such as spontaneous reduction of dissociation over time and placebo effects. Unmedicated patients with BPD [according to Diagnostic and Statistical Manual of Mental Disorders-IVth edition (DSM-IV)] were included in two small double-blind placebo-controlled randomized trials (total n=29). Patients received both 3 weeks of naltrexone (50 or 200 mg/day) and 3 weeks of placebo in a randomized order. Twenty-five patients completed the study according to protocol. Dissociation under naltrexone and placebo, respectively, was compared by repeated-measures analyses of variance. In either trial, both the intensity and duration of dissociative symptoms were numerically lower under naltrexone than under placebo. However, the effects were too small to reach statistical significance. Our data provide the first estimate of the pure pharmacological antidissociative efficacy of naltrexone from a rigorously designed trial.

Pharmacotherapy of borderline personality disorder: what has changed over two decades? A retrospective evaluation of clinical practice

“…Furthermore, an open label study showed reduction of dissociative symptoms in BPD females [41]. This finding could not be confirmed by a small cross-over placebo controlled study, perhaps due to the low power of the study [42]. Additionally, another RCT evaluating nalmefene in patients with BPD with comorbid alcohol abuse showed a significant reduction in heavy drinking days and a reduction in a BPD symptom list and CGI-BPD [43].…”

Complex Trauma in Adolescents and Adults

“…Although this is largely correct, there are some limited data on pharmacotherapy for dissociative symptoms. Several open trials 78 and one RCT 79 have suggested that naltrexone may help to reduce dissociative symptoms and posttraumatic flashbacks in borderline patients. Others have described its effectiveness in reducing self-injurious behavior in dissociative identity disorder.…”

Treatment-Induced Brain Plasticity in Borderline Personality Disorder: Review of Functional MRI Studies

“…A recent review supported the efficacy of SSRIs, in particular fluoxetine for impulsivity and affective symptoms; mood stabilizers among which valproate, topiramate, and lamotrigine demonstrated efficacy for affective symptoms related to anger and impulsive aggression; olanzapine was the most efficacious among second generation antipsychotics in targeting aggressiveness, affective and cognitive-perceptual symptoms [63]. Furthermore, recent efficacy studies point to novel drugs, such as opioid antagonist [64,65], clonidine [66,67], omega-3 fatty acids [68][69][70], and oxytocin [71][72][73] in reducing affective instability, impulsivity, self -injuries, and dissociative symptoms. Fundamentally, the abundance of options with poorly specified benefits have encouraged polypharmacy, which sometimes leads to undesirable side effects [74].…”