From the Research
For patients with emotionally unstable personality disorder, anxiety, and depression, a typical quetiapine dose increase is 50-100 mg every 1-2 weeks, up to a target dose of 300-450 mg/day, as supported by the most recent and highest quality study 1. Start with a low dose of 25-50 mg at bedtime, then increase gradually. Adjust based on individual patient response and tolerability. Monitor for side effects like sedation, weight gain, and metabolic changes. The slow titration helps minimize side effects while allowing time to assess efficacy. Quetiapine's mood-stabilizing and anxiolytic effects often require several weeks at therapeutic doses to become apparent. The extended-release formulation may be preferred for once-daily dosing and potentially fewer side effects. Some studies suggest that low dosages of quetiapine (150 mg/day) may be effective in reducing symptoms of borderline personality disorder, with fewer adverse events compared to higher dosages 1. Always combine medication with appropriate psychotherapy for optimal outcomes in personality disorders, as psychotherapy has been shown to be effective in reducing symptoms of personality disorders, even in the absence of pharmacological treatment 2. Regularly reassess the need for continued pharmacotherapy, as some patients may be able to taper off medication after achieving stability.
Key considerations when prescribing quetiapine for patients with emotionally unstable personality disorder include:
- Starting with a low dose and gradually increasing as needed and tolerated
- Monitoring for side effects and adjusting the dose accordingly
- Combining medication with psychotherapy for optimal outcomes
- Regularly reassessing the need for continued pharmacotherapy
- Being aware of the potential for off-label use of psychotropic medication in patients with emotionally unstable personality disorder, and the importance of systematic review and monitoring of treatment 3.
It is also important to note that basal exposure therapy, a novel ward-integrated psychotherapeutic approach, may be a promising treatment option for patients with severe and comorbid mental disorders, including emotionally unstable personality disorder 4. However, more research is needed to fully understand the effectiveness of this approach.