Lithium Therapy for Borderline Patients: Preliminary Findings

Journal of Personality Disorders, 4(2), 173-181, 1990

1990 The Guilford Press

LITHIUM THERAPY FOR BORDERLINE

PATIENTS: PRELIMINARY FINDINGS

Paul S. Links, MD, MSc, Meir Steiner, MD, PhD,

Ingrid Boiago, BA, RN, David Irwin, MD

This preliminary report of a double-blind random-order placebo

control cross-over trial of lithium carbonate and desipramine

in borderline personality disorder (BPD) addresses two

questions. (1) Is desipramine or lithium more effective than

placebo in reducing the affective symptoms in BPD? (2) What

are the perceptions of the patients and therapist regarding the

usefulness of desipramine or lithium versus placebo? The

patients received, in random order, either placebo, lithium, or

desipramine for 6-week intervals with a 2-week washout between each arm. Seventeen consenting patients have

completed involvement with the trial, 2 (11.8%) dropped out

prior to receiving medication, 5 (29.4%) dropped out after

completion of one arm, and 10 (58.8%) completed two or more

arms. Responses based on the Hamilton Depression Scale and

the Carroll Scale for Depression indicated no significant

differences between lithium versus placebo and desipramine

versus placebo. Regarding anger and suicidal symptoms, 8/11

patients on lithium versus 4/11 patients on desipramine improved (x2 2.93, df 1, p .09). Therapists' perceptions

rated lithium significantly superior to placebo [x2 4.54, df

1, p .03). These initial results suggest that the improvement noted on lithium may be related to its effects on the impulsive aspects of BPD.

The psychopharmacologic management of borderline patients is

can be summa

rized in the following way. First, when the literature is examined for the

strength of evidence by drug type, it is clear that antipsychotics have been

the most studied agents and evidence from 5 randomized control trials has

From Hamilton General Hospital and the McMaster Psychiatric Unit, St. Joseph's Hospital. Address correspondence to Paul S. Links, MD, Southam Building, Hamilton General Hospital,

237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.

This project was funded by

reports, naturalistic studies, and randomized control trials

a grant from the Ontario Ministry of Health. We also acknowledge

the support of the Hamilton General Hospital, Pfizer Canada Inc. for supplying Lithane, and

Merrell Dow Pharmaceuticals Inc. for supplying Norpramin.

173

now being

systematically studied and at least 6 randomized control trials exist on the subject (Links 6k Steiner, 1988)....