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An Open-Label Trial of Divalproex Extended-Release in the Treatment of Borderline Personality Disorder

ABSTRACT Introduction: Borderline personality disorder (BPD) is associated with several symptoms, including impulsivity, aggression, and intense unstable affect, which can be targeted with anticonvulsant agents. Divalproex extended-release (ER) is used widely in clinical practice, which leads to the question of its efficacy and tolerability in treating BPD. Methods: This study assessed the efficacy and tolerability of divalproex ER in 20 adult outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BPD via a 12-week openlabel trial. Primary outcome measures included the Clinical Global Impression–Improvement (CGI-I) scale and the Global Assessment Scale. Secondary outcome measures assessed aggression (Aggression Questionnaire, Overt Aggression Scale-Modified); affective disturbance (Affective Intensity Measure, Affective Lability Scale); dissociation (Dissociative Experiences Scale); and general psychopathology (Symptom-Checklist 90–Revised). Results: Thirteen subjects were male and seven were female with a mean age of 37.0±11.3 years. Treatment was associated with statistically significant improvement on the CGI-I, the Global Assessment Scale, the Overt Aggression Scale–Modified irritability subscale, and the Aggression Questionnaire. A trend toward significant improvement was observed on the Affective Intensity Measure. Seven out of 10 completers (70%) were treatment responders, with an endpoint CGI-I of 2 (much improved) or 1 (very much improved). There was no significant decline in affective lability or in dissociation. One participant discontinued treatment due to adverse events. Conclusion: These findings support that divalproex ER is an efficacious and well-tolerated pharmacologic agent for BPD, with the additional advantage of single daily dosing at bedtime. Placebo-controlled trials are needed for replication.