Olanzapine Superior to Fluoxetine for Borderline Personality Disorder

NEW YORK (Reuters Health) Aug 31 - Olanzapine (Zyprexa) and fluoxetine (Prozac) appear to be safe and effective agents for treating women with borderline personality disorder, study findings suggest. Olanzapine as monotherapy or combined with fluoxetine seems to be better for treating the chronic dysphoria and impulsive aggression associated with this disorder.

There are no recent studies comparing the efficacy of one class of psychotropic medication to another for borderline patients, Dr. Mary C. Zanarini, at McLean Hospital in Belmont, Massachusetts, and her team note in their paper in the Journal of Clinical Psychiatry for July. Their 8-week study compared olanzapine, an atypical antipsychotic, and fluoxetine, a selective serotonin reuptake inhibitor.

Their study cohort was recruited through newspaper advertisements for women "disturbed by moodiness, distrustfulness, impulsivity, and painful and difficult relationships." Subjects were included if they met standard criteria for borderline personality and did not meet criteria for current major depressive disorder.

Subjects were randomly assigned to fluoxetine, 10 to 30 mg (n = 14), olanzapine 2.5 to 7.5 mg (n = 16), or the combination (OFC, n = 15). Dose was adjusted by an unblinded psychiatrist.

Olanzapine and olanzapine plus fluoxetine were associated with greater degrees of improvement than fluoxetine alone. By the end of the 8-week study period, scores on the Montgomery-Asberg Depression Rating Scale had improved by 11.85 points in the OFC group, 13.63 points in the olanzapine group, and 8.23 points in the fluoxetine group.

Scores on the Modified Overt Aggression Scale showed a similar pattern, with improvements of 20.15 points, 19.69 points and 15.38 points, respectively.

That OFC seems to be superior to fluoxetine "is a new finding," Dr. Zanarini's group states, "and suggests that combining an atypical antipsychotic and an SSRI ... may lead to a greater reduction in both chronic dysphoria and impulsive aggression among borderline subjects" than an SSRI alone.

On average, those taking fluoxetine gained 0.8 pounds, while those on olanzapine gained 6.4 pounds and those on OFC gained 3.0 pounds. This led the group to suggest that "OFC may be a better choice if a borderline patient is particularly weight conscious."

J. Clin Psychiatry 2004;65:903-907.