From the Guidelines
For most patients with borderline personality disorder, starting with 10mg daily of olanzapine is recommended, with potential increases to 20mg only if there is insufficient response after an adequate trial period (typically 4-6 weeks) 1. The use of olanzapine in treating aggression and impulsivity in borderline personality disorder (BPD) should be approached with caution, considering the potential for increased side effects with higher doses.
- Key considerations include:
- The risk of sedation, weight gain, metabolic changes, and extrapyramidal symptoms associated with higher doses of olanzapine 1.
- The importance of using the lowest effective dose possible to minimize side effects and maximize the risk-benefit ratio.
- The need for regular reassessment of treatment to adjust the dose as necessary.
- Psychotherapy, particularly dialectical behavior therapy (DBT) or mentalization-based therapy, should be considered as part of a comprehensive treatment approach for BPD symptoms, rather than relying solely on medication 1.
- DBT has been shown to be effective in reducing suicidal ideation and behavior, as well as improving emotion regulation and distress tolerance in patients with BPD 1.
- The treatment approach should be individualized, taking into account the patient's specific needs and circumstances, and should involve a collaborative effort between the patient, their family, and mental health professionals.
From the Research
Efficacy of Olanzapine for Treating Aggression and Impulsivity in Borderline Personality Disorder
- The efficacy of olanzapine in treating aggression and impulsivity in borderline personality disorder has been studied in several trials 2, 3, 4, 5, 6.
- A study published in 2004 found that olanzapine was significantly superior to placebo in reducing symptoms of borderline personality disorder, including aggression and impulsivity 2.
- A systematic review of randomized trials published in 2010 found that olanzapine was one of the most effective medications for treating borderline personality disorder, particularly for reducing aggression and impulsivity 3.
- A 12-week randomized, double-blind, placebo-controlled study published in 2011 found that olanzapine 5-10 mg/d was associated with significantly greater improvement in borderline personality disorder symptoms, including aggression and impulsivity, compared to placebo 4.
- Another study published in 2005 found that olanzapine was associated with a statistically significant improvement in depression, anxiety, and impulsivity/aggressive behavior in patients with borderline personality disorder 5.
- A clinical trial published in 2010 found that olanzapine was effective in ameliorating symptoms of depression, anxiety, and aggression in patients with personality disorders on methadone maintenance therapy 6.
Comparison of 20mg and 10mg Doses of Olanzapine
- The study published in 2011 found that olanzapine 5-10 mg/d was associated with significantly greater improvement in borderline personality disorder symptoms compared to olanzapine 2.5 mg/d 4.
- However, there is no direct comparison of 20mg and 10mg doses of olanzapine in the provided studies.
- The study published in 2004 used a flexible dose range of 2.5 to 20 mg/day, with most patients receiving 5 to 10 mg/day, but did not compare the efficacy of different doses 2.
- The systematic review published in 2010 did not provide information on the optimal dose of olanzapine for treating borderline personality disorder 3.
Safety and Tolerability of Olanzapine
- The studies found that olanzapine was generally well-tolerated, but was associated with significant weight gain and other adverse events, such as somnolence, fatigue, and increased appetite 2, 4, 5, 6.
- The study published in 2011 found that the mean weight change from baseline to endpoint was significantly greater for olanzapine-treated patients compared to placebo-treated patients 4.