Young adults with borderline personality disorder heavily medicated after diagnosis
A Swedish study found that 90% of young adults receive CNS-acting medications in the year following a borderline personality disorder diagnosis, with antidepressants dominating. The finding raises questions about medication appropriateness for a condition where psychotherapy is typically first-line—signaling potential gaps in clinical practice and treatment guidelines that payers and health systems should address.
Originaltitel: Central nervous system acting medication used by young adults with borderline personality disorder in Sweden 2006–2019
Background: Most individuals diagnosed with borderline personality disorder (BPD) use psychotropic medications. BPD symptom severity is elevated in young adulthood, but medication utilisation studies in young adults with BPD are lacking. Aims: To investigate the use of central nervous system (CNS) acting medications among young adults (aged 18–24), who were diagnosed with BPD, focusing on the years around the first established diagnosis. Methods: A cohort study of all individuals with a registered BPD diagnosis in Sweden was conducted using national population register data. Dispensed prescriptions between July 2005 and June 2020 were utilised. Prevalent use, long-term use, and co-medication were investigated during specific 1-year periods: the year before, and then the first, second, and third year after diagnosis. Results: Medication use peaked for all three measures in the year following the first BPD diagnosis: 90.3% used CNS-acting medication during that year, and antidepressants were the most used group (70.1%). Furthermore, 74.5% used medication for >12 months, and 34.8% used ⩾3 medication groups in co-medication. Compared to a reference group of individuals diagnosed with depression, the BPD group used more medication. In the depression group, 87.5% used medication, 55.2% used medication for >12 months, and 3.8% used ⩾3 medication groups in co-medication. Moreover, medication use increased from 2006 to 2019. Conclusion: This indicates the importance of continuously evaluating risks and benefits with medication use, and in having easy access to up-to-date guidance about best clinical practice for individuals diagnosed with BPD, to facilitate appropriate and safe medication use.