Topiramate Treatment for Women With Borderline Personality Disorder

Abstract

Borderline personality disorder is a common and severe psychiatric illness. The goal of this study was to determine whether topiramate can influence patients' borderline psychopathology, health-related quality of life, and interpersonal problems. Women meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Structured Clinical Interview II criteria for borderline personality disorder were randomly assigned in a 1:1 ratio to topiramate titrated from 25 to 200 mg/d (n = 28) or placebo (n = 28) for 10 weeks. Primary outcome measures were changes on the Symptom-Checklist, on the SF-36 Health Survey, and on the Inventory of Interpersonal Problems. Body weight and additional side effects were assessed weekly. According to the intent-to-treat principle, significant changes (all P < 0.001) on the somatization, interpersonal sensitivity, anxiety, hostility, phobic anxiety, and Global Severity Index scales of the Symptom Checklist were observed in the topiramate-treated subjects after 10 weeks (no significant changes on the obsessive-compulsive, depression, paranoid ideation, and psychoticism scales). In the SF-36 Health Survey, significant differences were observed on all 8 scales (all P < 0.01 or P < 0.001). In the Inventory of Interpersonal Problems, significant differences (all P < 0.001) were found in the scales for overly autocratic, overly competitive, overly introverted, and overly expressive (no significant differences in the scales for overly cold, overly subassertive/subservient, overly exploitable/compliant, and overly nurturant/friendly). Weight loss was additionally observed (p < 0.001). Topiramate appears to be a safe and effective agent in the treatment in women with borderline personality disorder. Additional weight loss can be expected.

Psicofarmacología del suicidio II parte: Estabilizadores del ánimo y suicidio

“…Sin embargo, el estudio tuvo una corta duración, excluyéndose los casos con tendencias suicidas. En otros dos estudios se estableció que el topiramato se asociaba a disminución de irritabilidad, rabia, hostilidad, sensibilidad interpersonal, ansiedad fóbica y severidad global de la enfermedad 59,60 .…”

Borderline personality disorder: current drug treatments and future prospects

“…Topiramate and lamotrigine have both been shown in small RCTs to be effective in the treatment of symptoms of aggression in BPD [Nickel et al , 2004Tritt et al 2005]. In addition, there is evidence from one placebo-controlled trial of a broader effect of topiramate in treating other symptoms of BPD, including interpersonal problems and anxiety [Loew et al 2006]. Two small RCTs have demonstrated efficacy for divalproex sodium in the treatment of BPD [Hollander et al 2001], or BPD with comorbid bipolar II disorder [Frankenberg and Zanarini, 2002].…”

Pharmacotherapy of personality disorders: what we know and what we have to search for

“…A third 10-week RCT on topiramate (25-200 mg/day) conducted by Loew et al [48] in 56 females with BPD and concurrent mood disorders reported a significant reduction in somatization symptoms, interpersonal sensitivity, and hostility. Furthermore, an improvement of global functioning emerged from this set of data.…”