ABSTRACT
The usefulness of polyunsaturated fatty acids on inflammatory, cardiovascular, and the nervous system was studied in the last decades, but the mechanisms underlying their benefic properties are still partially unknown. These agents seem to express their action on the membrane phospholipid composition and permeability and modulation of second messenger cascades. In psychiatry, the efficacy and tolerability of omega-3 fatty acids were investigated in several psychiatric disorders, including major depression, bipolar disorder, personality disorders, high-risk conditions to develop psychosis, attention-deficit hyperactivity disorder, and autism spectrum disorders. Initial findings in this field are promising, and some relevant questions need to be addressed. In particular, the effects of these agents on the main symptom dimensions have to be investigated in a trans-diagnostic perspective. The present systematic review is aimed to examine the available data on the efficacy of omega-3 fatty acids on domains of psychotic symptoms, affective symptoms, impulsivity, and aggressiveness, and harmful behaviors, and suicide risk.
Subject(s)
Affective Symptoms/drug therapy , Autism Spectrum Disorder/drug therapy , Depressive Disorder, Major/drug therapy , Dietary Supplements , Fatty Acids, Omega-3/therapeutic use , Psychotic Disorders/drug therapy , Affective Symptoms/metabolism , Affective Symptoms/physiopathology , Antipsychotic Agents/therapeutic use , Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/metabolism , Attention Deficit Disorder with Hyperactivity/physiopathology , Autism Spectrum Disorder/metabolism , Autism Spectrum Disorder/physiopathology , Bipolar Disorder/drug therapy , Bipolar Disorder/metabolism , Bipolar Disorder/physiopathology , Depressive Disorder, Major/metabolism , Depressive Disorder, Major/physiopathology , Humans , Personality Disorders/drug therapy , Personality Disorders/metabolism , Personality Disorders/physiopathology , Psychopathology/methods , Psychotic Disorders/metabolism , Psychotic Disorders/physiopathology , Randomized Controlled Trials as Topic , Suicidal IdeationABSTRACT
Introduction: The treatment of borderline personality disorder (BPD) remains an open question for clinicians. There is scarce evidence available and the guidelines' conclusions diverge. Together with these factors, the complexity of BPD generates uncertainty in day-to-day practice. This narrative review aims to provide an overview of advances in BPD treatment and posit a critical opinion based on clinical evidence and practice.Areas covered: The authors review the clinical trials concerning the efficacy of the main classes of drugs in BPD: antidepressants, mood stabilizers, first-, second-, and third-generation antipsychotics, and other agents (opiate antagonists, clonidine, oxytocin, omega-3 fatty acids). They also include in this review studies on combinations of drugs and psychotherapies.Expert opinion: An individualized, tailored pharmacotherapy for BPD that targets the prominent symptom clusters can improve relevant aspects of the clinical picture. However, no medication is indicated to treat the global psychopathology of BPD. Polypharmacy should be avoided or strictly limited. To date, pharmacotherapy alone does not suffice to manage the complexity of BPD. Combining medication with psychotherapy may improve specific BPD symptom dimensions. In particular, it may help those aspects that respond slowly or not at all to monotherapy.
