Lamotrigine for Borderline Personality Disorder

Efficacy and Evidence

The American Academy of Child and Adolescent Psychiatry suggests that lamotrigine is approved for maintenance therapy in bipolar disorder in adults, but not specifically for borderline personality disorder, with evidence from 2007 studies 1, 2

The American College of Physicians, as published in the Annals of Internal Medicine, recommends Dialectical Behavior Therapy (DBT) as a first-line treatment for borderline personality disorder, due to its strong evidence in reducing self-directed violence 3, 4
The evidence suggests considering mood stabilizers like valproate, which may have better evidence than lamotrigine for symptom management in BPD, as reported in Molecular Psychiatry 5
Atypical antipsychotics may be beneficial for specific symptoms like psychomotor agitation in BPD patients, according to the Journal of the American Academy of Child and Adolescent Psychiatry 1, 2

Individuals with BPD and comorbid bipolar disorder might benefit more from lamotrigine than those with BPD alone, as noted in Molecular Psychiatry 5
The American College of Emergency Physicians, as published in the Annals of Emergency Medicine, advises that lamotrigine should be avoided in patients with a history of serious rash reactions to the medication 6

Careful differential diagnosis is essential to avoid misdiagnosing BPD as bipolar disorder or vice versa, which can lead to inappropriate treatment choices, as reported in Molecular Psychiatry 5
Relying solely on pharmacotherapy without concurrent psychotherapy, particularly DBT, is less likely to produce meaningful improvements in BPD symptoms, according to the Annals of Internal Medicine 3, 4
Discontinuing medication abruptly can lead to withdrawal symptoms or symptom exacerbation, as noted in the Journal of the American Academy of Child and Adolescent Psychiatry 2