From the Guidelines
Lurasidone (Latuda) should not be considered a first-line treatment for borderline personality disorder (BPD), as the most effective treatment supported by evidence is Dialectical-Behavioral Therapy (DBT) 1. When considering pharmacological interventions for BPD, it's crucial to prioritize treatments that have shown efficacy in reducing symptoms and improving quality of life.
- The primary goal in treating BPD is to reduce morbidity and mortality, particularly from suicidal behaviors, and improve the patient's quality of life.
- DBT, as described by Linehan (1993a,b), has been shown in randomized controlled trials to reduce suicidality in adults with BPD, making it the preferred treatment approach 1.
- While Lurasidone (Latuda) may be prescribed off-label for BPD, targeting symptoms like mood instability or impulsivity, its use should be adjunctive to psychotherapy and part of a comprehensive treatment plan.
- The dosing of Latuda for approved conditions ranges from 20-120mg daily, but its use in BPD is not well-studied, and thus, starting with lower doses (20-40mg) and gradual increases based on response and tolerability is prudent.
- Common side effects of Latuda include nausea, somnolence, akathisia, and metabolic changes, which must be monitored closely.
- The rationale for using atypical antipsychotics like Latuda in BPD is their potential to regulate emotional responses and impulsive behaviors through their effects on dopamine and serotonin receptors.
- However, given the lack of strong evidence supporting the use of Latuda for BPD and the established efficacy of DBT, psychotherapy should remain the cornerstone of treatment, with medications considered only when necessary and as part of a broader treatment strategy 1.
From the Research
Latuda for Borderline Personality Disorder
- There is no direct evidence to suggest that Latuda is specifically used to treat borderline personality disorder (BPD) 2, 3, 4, 5, 6.
- The current treatment for BPD primarily involves psychotherapy, with various approaches such as dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy showing empirical support in randomized controlled trials 2, 6.
- Pharmacotherapy may be useful for discrete and severe comorbid symptoms such as anxiety or depressive symptoms, but there is no evidence to suggest that any psychoactive medication is efficacious for the core features of BPD 2, 4, 5.
- Some studies suggest that second-generation antipsychotics, anticonvulsants, and antidepressants may have limited efficacy in reducing specific symptoms associated with BPD, but the evidence is mostly limited to single studies and the overall efficacy of pharmacotherapies for BPD is limited 4, 5.
- Combining medication with psychotherapy may improve specific BPD symptom dimensions, but pharmacotherapy alone does not suffice to manage the complexity of BPD 5, 6.