Collaborative Deprescribing in Borderline Personality Disorder: A Narrative Review

Area of Science:

• Psychiatry
• Pharmacology
• Clinical Psychology

Background:

• Psychopharmacology for borderline personality disorder (BPD) is challenging due to comorbidities, substance use, side effect sensitivity, self-harm risks, and fluctuating symptoms.
• Patient-medication relationships significantly impact treatment response, necessitating flexible and evidence-based prescribing approaches.

Purpose of the Study:

• To review current medication management strategies for BPD, focusing on the complexities of polypharmacy.
• To illustrate the application of deprescribing as an active intervention to optimize medication regimens in BPD patients.

Main Methods:

• A narrative review approach was employed, utilizing a clinical vignette to explore polypharmacy challenges.
• The framework of deprescribing, adapted from geriatric medicine, was applied to a BPD case to demonstrate medication reduction.

Main Results:

• Polypharmacy in BPD presents significant limitations, often driven by complex patient factors and symptom variability.
• Deprescribing, emphasizing risk-benefit analysis and patient preferences, provides a structured method for simplifying medication regimens.

Conclusions:

• Flexible and responsive medication management, incorporating deprescribing principles, is crucial for patients with BPD.
• Future research should investigate targeted intermittent medication treatments and the efficacy of deprescribing in BPD populations.