The meaning of lithium and naltrexone pharmacotherapy in the treatment of borderline personality disorder – a narrative review

Authors

  • Zuzanna Joanna Wingralek Student Research Group at the I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland Author https://orcid.org/0000-0003-3253-9345
  • Aleksandra Marczak Student Research Group at the I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland Author https://orcid.org/0000-0001-5950-3567
  • Justyna Tomasik Student Research Group at the I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland Author https://orcid.org/0000-0001-6114-6992
  • Adrian Giermasiński Student Research Group at the I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland Author
  • Michał Dzikowski I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland Author https://orcid.org/0000-0002-4252-7308

DOI:

https://doi.org/10.12923/2353-8627/2023-0018

Keywords:

borderline, lithium, naltrexone

Abstract

Introduction: Borderline personality disorder (BPD) affects approximately 1%-3% of the population. As the most common personality disorder, BPD features behavioural, emotional and social dysfunctions. It often co-occurs with self-harm, suicidal tendencies and substance abuse. To date, pharmacological treatment does not provide sufficient therapeutic effects. The aim of our study is to analyse the neurobiological, genetic and environmental components in the aetiopathogenesis of BPD and to collect data on the innovative use of lithium and naltrexone in the therapy of BPD.

Methods: Basing on PubMed and Google Scholar databases using the following keywords: borderline, lithium, naltrexone for papers published from 1979 to 2022.

Results: Difficult childhood, and emotional, sexual and physical abuse are the strongest predictors of BPD development. The core symptoms of BPD may be related to dysfunction of the serotonin, dopaminergic, endogenous system and opioid systems. Variation in 5-HTT, COMT, FKBP5 and oxytocin receptor genes may influence the course of BPD. Imaging studies have shown structural and functional abnormalities in the prefrontal cortex, amygdala and hippocampus. Lithium reduces impulsivity, aggression, suicidal tendencies and self-harm in BPD. Naltrexone may effectively reduce self-harm without suicidal tendencies, impulsivity, substance abuse and suicidality.

Conclusions: No unified model has been developed to account for environmental, genetic and neurobiological components in the pathogenesis of BPD. Understanding the mechanisms is a crucial step towards personalising treatment. The use of lithium and naltrexone may have positive therapeutic effects. Randomised clinical trials are required to establish the efficacy and safety of both drugs in long-term treatment.

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Published

2024-09-08

Issue

Vol. 24 (2023): Current Problems of Psychiatry

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Artykuły

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