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Lamotrigine ineffective for borderline personality disorder

Lamotrigine for borderline personality disorder was neither clinically effective nor cost effective, according to study findings published in The American Journal of Psychiatry.

“Evidence that lamotrigine may prevent relapse in rapid-cycling bipolar disorder makes it particularly worthy of testing among people with borderline personality disorder,” Mike J. Crawford, MD, from the Center for Psychiatry, Imperial College London, and colleagues wrote. “Two small randomized trials reported reduced impulsivity and affective lability among patients treated with lamotrigine compared with those treated with an inactive placebo. Both were preliminary studies, however, and they examined only short-term effects.”

To determine the clinical effectiveness and cost-effectiveness of lamotrigine for the treatment of borderline personality disorder, researchers conducted a phase 3, double-blind, placebo-controlled randomized trial. The investigators randomly allocated 276 adults with borderline personality disorder (1:1) to receive either inert placebo or up to 400 mg per day of lamotrigine, and assessed their scores on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. They also examined depressive symptoms, self-harm, social functioning, health-related quality of life, resource use and costs, and adverse events after treatment.

At 52 weeks, 49 participants in the lamotrigine group and 58 in the placebo group were still taking their study medication. Although the mean ZAN-BPD score decreased in both groups at 12 weeks, it remained stable throughout the remainder of the follow-up period. Mean scores in the lamotrigine group were 11.5 at 12 weeks, 11.9 at 24 weeks and 11.3 at 52 weeks, compared with 11.5, 11.9 and 11.5 in the placebo group, indicating no difference in score at the end of the follow-up period.

Furthermore, Crawford and colleagues observed no differences in depressive symptoms, self-harm, social functioning, health-related quality of life, resource use and costs, and adverse events between the treatment groups. During the 6 months prior to randomization, the average cost for participants in the lamotrigine group was $8,160 and $5,163 in the placebo group. Over the 52 weeks, the average costs were $17,785 for the lamotrigine group and $12,340 for the placebo group (adjusted difference = $931.99; P = .62).

“Based on the results of this trial, we do not recommend that people with borderline personality disorder be treated with lamotrigine,” Crawford and colleagues wrote. “While pharmacological treatment of coexisting mental health conditions is important, we did not find evidence to support the use of lamotrigine for treatment of the core symptoms of borderline personality disorder.” – by Savannah Demko

Disclosures: Crawford reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.