An initial step toward symptom-based pharmacotherapy for borderline personality disorder: a systematic review and meta-analysis
Abstract
Although no pharmacological treatments have received regulatory approval for borderline personality disorder (BPD), antipsychotic medications—particularly haloperidol, olanzapine, and risperidone—are frequently prescribed off-label in clinical practice. This study aims to quantitatively compare the efficacy of these three agents in the management of BPD. Moreover, considering the heterogeneous presentations of BPD among patients, the efficacy of these agents is also quantitatively compared in controlling individual symptom domains, including depression, anxiety, interpersonal challenges, cognitive impairment, impulsivity, and hostility. Due to the lack of head-to-head trials, indirect comparisons were conducted through a meta-analysis of effect sizes derived from open-label studies. A total of 21 studies met the inclusion criteria and were included in the analysis. In the overall assessment, risperidone demonstrated the greatest effect size (− 1.99 [− 2.34, − 1.64], p < 0.001), followed by haloperidol (− 0.98 [− 1.25, − 0.72], p < 0.001) and olanzapine (− 0.85 [− 1.24, − 0.46], p < 0.001). Comparative analyses of these agents across six core symptom domains are presented in the graphical abstract. Subgroup analyses indicated that olanzapine may exert greater efficacy in female patients and individuals under the age of 30, with the most favorable outcomes observed when treatment duration approaches 8–9 weeks. Overall, the certainty of evidence was low to moderate, primarily…
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