From the Research
Memantine is not recommended as a first-line treatment for Borderline Personality Disorder (BPD). The current first-line treatments for BPD are psychotherapeutic approaches, particularly evidence-based options like Dialectical Behavior Therapy (DBT), Mentalization-Based Treatment (MBT), and Schema-Focused Therapy 1. While memantine has shown some promise in small studies for reducing impulsivity and aggression in BPD patients, the evidence is preliminary and insufficient to support its use as a primary treatment.
When medication is needed for BPD, clinicians typically target specific symptom clusters with selective serotonin reuptake inhibitors (SSRIs) for mood instability and impulsivity, or low-dose atypical antipsychotics for cognitive-perceptual symptoms. Memantine works by modulating glutamate activity through NMDA receptor antagonism, which theoretically could help with emotional regulation, but this mechanism hasn't translated to robust clinical evidence in BPD treatment 2.
Some studies suggest that memantine may be effective as an adjunctive treatment in BPD, with a significant change in total score of ZAN-BPD symptom severity observed in the memantine group at 20 mg/daily across time, compared with placebo (p = 0.02) 3. However, the evidence is limited, and more research is needed to fully understand the efficacy of memantine in BPD treatment.
Patients seeking treatment for BPD should first pursue psychotherapy options and consider medication only as an adjunctive approach targeting specific symptoms under proper psychiatric supervision. The selection of treatment should be based on individual patient characteristics, and combining information from multiple moderators may help inform providers and patients as to which treatment is the most likely to lead to long-term symptom relief 4.
Key points to consider:
- Psychotherapy is the first-line treatment for BPD
- Memantine is not recommended as a primary treatment for BPD
- Medication should be used as an adjunctive approach targeting specific symptoms
- Treatment selection should be based on individual patient characteristics
- More research is needed to fully understand the efficacy of memantine in BPD treatment.