Most authorities in the world of borderline personality disorder (BPD) say that psychotherapy is the mainstay of treatment and that medications should only be used adjunctively to treat symptoms as they arise. Nevertheless, medications are used relatively frequently for this disorder.

Cephalon’s selective GABA reuptake inhibitor, the antiepileptic drug tiagabine (Gabitril), was assessed for the treatment of generalized anxiety disorder in adults in three large 10-week placebo-controlled studies.

The FDA issued a Not Approvable letter regarding Vanda Pharmaceutical’s antipsychotic medication iloperidone (Fanapta). The agency based its decision on iloperidone’s question able efficacy results versus risperidone.

Based on data from eight randomized double-blind, placebo-controlled trials, researchers found that 79% of patients who responded to placebo in the initial phase of the trial maintained their response while continuing to take placebo during the continuation phase of the trial.

An intensive two-year-long early intervention for first episode psychosis showed early promise relative to standard care, yielding superior improvement in both positive and negative symptoms, as well as lower rates of substance abuse and lower antipsychotic medication doses.

After reading these articles, you should be able to…

Much of what is confusing and controversial in the treatment of bipolar disorder revolves around the role of antidepressants. Are they dangerous or safe? Are they effective or ineffective? Does it matter whether the patient has Bipolar I or II?

Lamictal (lamotrigine) is immensely popular among American psychiatrists. A recent survey found that it is prescribed more frequently than any other mood stabilizer (Clin Psychiatry News, June 2008, page 1).

While we have become sensitized to worrying about weight gain caused by antipsychotics, this side effect does occur with standard mood stabilizers as well. Recently, a comprehensive literature review was published evaluating the weight gain liabilities of medications commonly used to treat bipolar disorder (Torrent et al., Acta Psychiatrica Scand 2008;118:4-18). Here is what they found.

Dr. Phelps, before we begin, I know that you have always been very up front about the fact that you speak for drug companies, and I wonder how you think this might influence what you have to say about the diagnosis of bipolar disorder?