The following articles are currently In Press and will be published in the next issue of
IN PRESS: Efficacy and Tolerability of Lamotrigine in Borderline Personality Disorder: A Systematic Review and Meta-Analysis
Mehak Pahwa, MD; Nicolas A Nuñez, MD; Boney Joseph, MBBS; Ashok Seshadri; Danielle J. Gerberi; Mark A Frye AND Balwinder Singh
Background: Patients with Borderline Personality Disorder (BPD) have a high prevalence of mood disorders. Lamotrigine (LAM) is often used as an off-label therapeutic option for BPD. We aimed to conduct a systematic review and meta-analysis to assess the efficacy and tolerability of LAM for the treatment of BPD.
Methods: We comprehensively searched electronic databases for eligible studies from the inception of databases to September 2019. Outcomes investigated were BPD dimensions, tolerability, and adverse events. Quality assessments were completed for the included studies. Data were summarized using random-effects model.
Results: Of the 619 records, five studies, including three randomized controlled trials (RCT; N=330) were included for the qualitative analysis. A meta-analysis conducted on two RCTs measuring LAM efficacy at 12 weeks, showed no statistically significant difference at 12 weeks (SMD: -0.04; 95%CI: -0.49, 0.41; p=0.87; I2=38%) and at study endpoints (SMD: 0.18, 95%CI: -0.89, 1.26; p=0.74; I2=86%) as compared to placebo. Sensitivity analysis on three RCTs measuring impulsivity/aggression showed no statistically significant difference between LAM and placebo (SMD: -1.84, 95%CI: -3.94, 0.23; p=0.08; I2= 95%). LAM was well tolerated, and quality assessment of the included trials was good.
Conclusions: Our results suggest there is limited data regarding efficacy of lamotrigine in BPD. There was no consistent evidence of lamotrigine’s efficacy for the core symptom domains of BPD. Future studies should focus on examining targeted domains of BPD to clarify sub-phenotypes and individualized treatment for patients with BPD.
IN PRESS: The Use of Prazosin in Treatment of Drug Dreams in Adolescents with Substance Use Disorder: Two Case Reports
By Arpit Aggarwal and Victoria Lindegaard
ABSTRACT ~ Nightmares are psychologically distressing events that may cause significant effects on mental health, physical well-being and overall quality of life, in addition to their negative impact on quality and duration of sleep. Drug dreams are a variant of nightmares and a known phenomenon in addiction medicine, and have been studied as a potential causative factor in relapse of substance use. Recent studies have noted that addictive behaviors and drug dreams share a similar neurobiological pathway, and that certain neurotransmitters, most notably those of the noradrenergic system, may underlie these complex processes. This has led to the theory that alleviation of drug dreams and suppression of involved neurocircuits may potentially reduce subsequent craving and relapse in the treatment of substance use disorders, with an important potential agent being the alpha-1 antagonist, prazosin.