From the Research
Aripiprazole is not approved by the FDA or other major regulatory agencies for the treatment of borderline personality disorder (BPD). Aripiprazole (brand name Abilify) is an atypical antipsychotic that is approved for conditions such as schizophrenia, bipolar disorder, major depressive disorder (as an adjunct therapy), and irritability associated with autism. While some psychiatrists may prescribe aripiprazole off-label for certain symptoms associated with BPD, such as impulsivity, mood instability, or psychotic-like symptoms, this use is not officially approved, as noted in a systematic review published in 2021 1. Currently, there are no medications specifically approved for BPD. The primary recommended treatment for BPD is psychotherapy, particularly dialectical behavior therapy (DBT), schema therapy, or mentalization-based therapy. When medications are used in BPD, they typically target specific symptoms rather than the disorder as a whole, as supported by a study published in 2023 that found aripiprazole to be effective in reducing anxiety, depression, anger, hostility, and other symptoms in patients with BPD, although the study highlighted the need for more randomized controlled trials 2. Patients with BPD should work closely with mental health professionals to develop a comprehensive treatment plan that primarily focuses on psychotherapy while considering medication only for specific symptom management. Some studies have shown that aripiprazole may be effective in reducing symptoms of BPD, such as a study published in 2006 that found significant changes in scores on most scales of the symptom checklist (SCL-90-R), Hamilton depression rating scale (HAM-D), and Hamilton anxiety rating scale (HAM-A) in patients treated with aripiprazole 3, and another study published in 2007 that found significant changes on all scales of the SCL-90-R, HAM-D, HAM-A, and state-trait anger expression inventory (STAXI) in patients treated with aripiprazole for 18 months 4. However, the evidence is not strong enough to support the use of aripiprazole as a first-line treatment for BPD, and more research is needed to fully understand its efficacy and safety in this population. In clinical practice, aripiprazole may be considered as an off-label treatment option for patients with BPD who have not responded to other treatments, but its use should be carefully monitored and weighed against the potential risks and benefits, as noted in a study published in 2006 that reported side effects such as headache, insomnia, nausea, numbness, constipation, and anxiety in patients treated with aripiprazole 3.