From the Research
For patients with Borderline Personality Disorder (BPD) currently on quetiapine 50mg, a cautious titration approach is recommended, increasing by 50mg every 3-7 days, targeting a typical therapeutic range of 150-300mg daily for BPD symptoms, with a maximum of 400mg daily in divided doses, as supported by the most recent study 1.
Key Considerations
- The titration approach should be gradual to minimize side effects like sedation, dizziness, and orthostatic hypotension.
- Morning doses should be smaller than evening doses to reduce daytime sedation.
- Monitor for metabolic effects (weight gain, blood glucose, lipids), extrapyramidal symptoms, and QTc prolongation, especially with dose increases, as noted in various studies 2, 3, 1, 4.
- Effectiveness should be assessed after 4-6 weeks at a stable dose.
- Quetiapine for BPD is often used off-label primarily for emotional dysregulation, impulsivity, and aggression rather than psychotic symptoms, and should be part of a comprehensive treatment plan including psychological therapies.
Supporting Evidence
- A 2007 study 1 found that quetiapine was effective in treating BPD features, including affective dysregulation and aggression, with an average daily dosage of 540 mg.
- Another study from 2005 4 also showed that quetiapine relieved symptoms of psychosis, reduced impulsivity or depressed mood, and improved global functioning in patients with BPD and psychosis.
- While older studies 2, 3, 5 provide some insight into the use of quetiapine in personality disorders, the most recent and relevant study 1 guides the recommended titration approach for BPD patients.