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Evaluation of naltrexone for dissociative symptoms in borderline personality disorder

Schmahl, Christian*a; Kleindienst, Nikolaus*a; Limberger, Matthiasa; Ludäscher, Petraa; Mauchnik, Janaa; Deibler, Petera; Brünen, Sonjab; Hiemke, Christophb; Lieb, Klausb; Herpertz, Sabinec; Reicherzer, Markusd; Berger, Mathiase; Bohus, Martina

International Clinical Psychopharmacology: January 2012 - Volume 27 - Issue 1 - p 61–68
doi: 10.1097/YIC.0b013e32834d0e50
Original Articles

Data from a pilot study suggest that naltrexone might reduce dissociative symptoms in patients with borderline personality disorder. However, the interpretation of these data is limited by the lack of a control group and by the nonblind nature of this study. Hence, we examined the effects of naltrexone using a more rigorous design that controlled for major confounders such as spontaneous reduction of dissociation over time and placebo effects. Unmedicated patients with BPD [according to Diagnostic and Statistical Manual of Mental Disorders-IVth edition (DSM-IV)] were included in two small double-blind placebo-controlled randomized trials (total n=29). Patients received both 3 weeks of naltrexone (50 or 200 mg/day) and 3 weeks of placebo in a randomized order. Twenty-five patients completed the study according to protocol. Dissociation under naltrexone and placebo, respectively, was compared by repeated-measures analyses of variance. In either trial, both the intensity and duration of dissociative symptoms were numerically lower under naltrexone than under placebo. However, the effects were too small to reach statistical significance. Our data provide the first estimate of the pure pharmacological antidissociative efficacy of naltrexone from a rigorously designed trial.

aDepartment of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim

bDepartment of Psychiatry and Psychotherapy, University Medical Center, Mainz

cDepartment of Psychiatry, University of Heidelberg, Heidelberg

dCenter for Psychosomatic Medicine, Wiessee

eDepartment of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany

Christian Schmahl and Nikolaus Kleindienst contributed equally to this study.

Correspondence to Nikolaus Kleindienst, PhD, Dipl.-Stat, Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, J5, Mannheim D-68159, Germany Tel: +49 621 1703 4404; fax: +49 621 1703 4405; e-mail: nikolaus.kleindienst@zi-mannheim.de

Received June 3, 2011

Accepted September 12, 2011

© 2012 Lippincott Williams & Wilkins, Inc.