AN OPEN TRIAL OF VALPROATE IN BORDERLINE PERSONALITY-DISORDER

Background: Target symptoms in pharmacotherapy of borderline personali ty disorder include mood instability, anxiety, and impulsivity. Valpro ate appears useful for the treatment of these target symptoms in sever al disorders, and carbamazepine has been found effective for such symp toms in borderline personality disorder. We therefore conducted a prel iminary open-label trial of valproate in borderline personality disord er. Method: Eleven patients who met DSM-III-R criteria for borderline personality disorder were entered into an 8-week study of valproate. E xclusion criteria included current major depression or major medical d isorder. All patients were in psychotherapy at least once a week for a minimum of 8 weeks prior to starting medication. Valproate was increa sed as tolerated to reach blood levels of 50 to 100 mu g/mL. Clinician - and self-rated scales were completed each week. Results: Three patie nts did not complete the study. Of completers, 3 of 8 patients were re sponders (''much less'' or ''less'') on clinician-rated change scores for overall pathology and for mood. Three of 8 patients were responder s on change scores for anxiety, anger, impulsivity, and rejection sens itivity. There was a significant (p =.03) decrease in total Symptom Ch ecklist-90 scores between the start and end of the trial. On the Overt Aggression Scale (Modified), total other-directed assault did not sig nificantly decrease, but there was a significant (p =.02) decrease in global subjective irritability. Conclusion: Valproate led to overall i mprovement in 50% of a small sample of borderline personality disorder patients who completed an 8-week open trial. The medication was modes tly helpful for mood and irritability as well as for anxiety, anger re jection sensitivity, and impulsivity, but specific therapeutic effects varied from patient to patient. More extensive controlled trials of a nticonvulsants for impulsive personality disorders are warranted.