In Borderline Personality Disorder (BPD), pharmacotherapy is used for the treatment of specific BPD pathology facets, such as cognitive-perceptual, affective, or impulsivity symptoms. Due to the polymorphic phenomenology of the disorder, different classes of drugs are used, e.g., antipsychotics, antidepressants, or mood stabilizers.

To evaluate the up-to-date evidence of drug treatment efficacy for BPD.

A systematic review and metaanalysis of randomised controlled trials was done. All randomised comparisons of drug vs. placebo, drug vs. drug, or drug vs. a combination of drugs in adult BPD patients were eligible for inclusion. Outcomes comprised BPD core pathology as depicted by DSM criteria, associated pathology, i.e., depression and anxiety, general measures of overall psychopathology severity and mental health status, tolerability, and adverse effects. With support of the Cochrane Collaboration, a thorough search was conducted to identify both published and unpublished trials. The findings were scrutinized by two reviewers independently.

Twenty-six trials were included, investigating first- and second-generation antipsychotics, mood stabilizers, antidepressants, and omega-3 fatty acids.

Findings indicate beneficial effects for all classes of drugs investigated, and suggest mood stabilizers and second-generation antipsychotic agents as first-line treatments for BPD due to their efficacy in the treatment of different domains of BPD and associated pathology. However, psychotherapeutic treatment should clearly be targeted at predefined specific symptoms.