Six months of dialectical behavior therapy (DBT) is more effective than antidepressants at reducing suicidal and self-injury behaviors in at-risk adults with borderline personality disorder, according to a new study in AJP.Antidepressants were more effective at managing comorbid depression and were comparable to DBT for some other outcomes, however.
Beth S. Brodsky, Ph.D., of Columbia University, and colleagues noted this comparison of antidepressants to a proven psychotherapy is clinically important as there is no single recommended psychopharmacological best practice for the prevention of suicide or self-injury in individuals with borderline personality disorder.
A Population At-Risk
The researchers recruited 84 adults (ages 18-55) with borderline personality disorder and a history of suicide attempt, significant suicidal ideation, and/or nonsuicidal self-injury; most had comorbid major depressive disorder.
Participants were randomly assigned to receive six months of DBT (one weekly individual session, weekly skills group, and between-session coaching by phone) or six months of treatment with a selective serotonin reuptake inhibitor (SSRI); participants started on fluoxetine, then switched to citalopram and finally paroxetine if they did not respond to or tolerate the previous medication.
Adults in the SSRI arm also received biweekly 30-minute sessions with a psychiatrist for medication management, psychoeducation, and general support.
Both Treatments Offer Benefits
After six months, fewer participants receiving DBT had one or more suicide-related events (defined as a suicide attempt, aborted/interrupted attempt, or suicidal ideation that required emergency care or hospitalization) compared to those receiving SSRIs—four versus 12, respectively. The DBT arm also had about 30% fewer episodes of nonsuicidal self-injury compared with the SSRI group.
Both groups showed similar improvements in core borderline personality symptoms, however. In addition, just 3% of participants receiving SSRIs met diagnostic criteria for major depression at six months, versus 26% of those receiving DBT.
“The antidepressants [also worked] a little quicker at easing depression, which is important in a high-risk suicidal population,” Brodsky told Psychiatric News. “This shows that medication can be extremely efficacious for people with [BPD] who also have clearly defined major depressive disorder.”
For related information, see APA’s Focus article, “Practice Assessment Tool for the Care of Patients With Borderline Personality Disorder.”
(Image: Getty Images/iStock/dragana991)
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