From the Guidelines
Chlorpromazine is not recommended for treating personality disorders due to its significant side effects and lack of evidence supporting its effectiveness for this condition. While chlorpromazine is an antipsychotic medication primarily used for conditions like schizophrenia, bipolar disorder, and severe behavioral problems, there is limited evidence supporting its use for personality disorders 1. For personality disorders, first-line treatments typically include psychotherapy approaches such as:
- Dialectical behavior therapy (DBT)
- Cognitive behavioral therapy (CBT)
- Schema therapy If medication is needed for specific symptoms in personality disorders, psychiatrists may consider targeted symptom-based approaches using other medications like:
- Selective serotonin reuptake inhibitors (SSRIs) for mood symptoms
- Low-dose atypical antipsychotics for brief periods to address severe agitation or psychotic-like symptoms Chlorpromazine has significant side effects including sedation, orthostatic hypotension, anticholinergic effects, and risk of tardive dyskinesia with long-term use, making it generally unsuitable as a primary treatment for personality disorders where the risk-benefit ratio would not favor its use. Treatment for personality disorders is most effective when it involves a comprehensive approach focusing on therapy with medication used only as an adjunct for specific symptoms rather than as the primary intervention. The use of chlorpromazine in clinical practice is more commonly associated with psychotic symptoms, as noted in the practice parameter for the assessment and treatment of children and adolescents with schizophrenia 1, but its application to personality disorders is not supported by strong evidence.
From the Research
Effectiveness of Chlorpromazine for Personality Disorders
- There is no direct evidence to suggest that chlorpromazine is effective for treating personality disorders 2.
- Chlorpromazine is primarily used to treat psychotic disorders, such as schizophrenia, and has been shown to be effective in reducing symptoms of psychosis 3, 4.
- However, chlorpromazine may be used off-label to treat acute crisis in borderline personality disorder, consisting of suicidal behavior or ideation, extreme anxiety, psychotic episodes, or other extreme behavior likely to endanger a patient or others 2.
Safety and Tolerability of Chlorpromazine
- Chlorpromazine has been associated with a range of side effects, including extrapyramidal symptoms, weight gain, and metabolic abnormalities 3, 5.
- The safety and tolerability profile of chlorpromazine is generally considered to be less favorable than that of second-generation antipsychotics 5.
- However, chlorpromazine may still be used in certain situations, such as when other treatment options are not available or have failed 6.
Clinical Application of Chlorpromazine
- Chlorpromazine is typically used at low doses (≤ 400 mg/day) for the treatment of psychotic disorders 3.
- The dosage of chlorpromazine has changed over time, with lower doses now being preferred due to the risk of side effects 3.
- Chlorpromazine may be used in combination with other medications, such as selective serotonin reuptake inhibitors, to treat co-occurring mental health conditions 2.