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Schulkens J, Bergs N, Ingenhoven T, et al. Selective Serotonin Reuptake-Inhibitors for Symptom-Based Treatment of Borderline Personality Disorders in Older Adults: An International Delphi Study. Clin Psychopharmacol Neurosci. 2021;19(1):53-62doi: 10.9758/cpn.2021.19.1.53.
Schulkens, J., Bergs, N., Ingenhoven, T., Rosowsky, E., Alphen, S. V., & Sobczak, S. (2021). Selective Serotonin Reuptake-Inhibitors for Symptom-Based Treatment of Borderline Personality Disorders in Older Adults: An International Delphi Study. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 19(1), 53-62. https://doi.org/10.9758/cpn.2021.19.1.53
Schulkens, Julie, et al. "Selective Serotonin Reuptake-Inhibitors for Symptom-Based Treatment of Borderline Personality Disorders in Older Adults: An International Delphi Study." Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology vol. 19,1 (2021): 53-62. doi: https://doi.org/10.9758/cpn.2021.19.1.53
Schulkens J, Bergs N, Ingenhoven T, Rosowsky E, Alphen SV, Sobczak S. Selective Serotonin Reuptake-Inhibitors for Symptom-Based Treatment of Borderline Personality Disorders in Older Adults: An International Delphi Study. Clin Psychopharmacol Neurosci. 2021 Feb 28;19(1):53-62. doi: 10.9758/cpn.2021.19.1.53. PMID: 33508788; PMCID: PMC7851470.
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Clin Psychopharmacol Neurosci. 2021 Feb 28;19(1):53-62. doi: 10.9758/cpn.2021.19.1.53.

Selective Serotonin Reuptake-Inhibitors for Symptom-Based Treatment of Borderline Personality Disorders in Older Adults: An International Delphi Study.

Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology

Julie Schulkens, Nina Bergs, Theo Ingenhoven, Erlene Rosowsky, Sebastiaan van Alphen, Sjacko Sobczak

Affiliations

  1. Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Hospital, Heerlen, The Netherlands.
  2. School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre?, Maastricht, The Netherlands.
  3. Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
  4. Arkin Mental Healthcare, NPI Center for Personality Disorders, Amsterdam, The Netherlands.
  5. Department of Clinical Psychology, William James College, Newton, MA, USA.
  6. Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
  7. Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel, Brussels, Belgium.
  8. Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.

PMID: 33508788 PMCID: PMC7851470 DOI: 10.9758/cpn.2021.19.1.53

Abstract

OBJECTIVE: International guidelines on symptom-based treatment of borderline personality disorders (BPD) in older adults are lacking. The number of older adults (≥ 65 years) with borderline personality disorder is rising. Effectiveness of Selective Serotonin Reuptake Inhibitors (SSRIs) on symptoms of BPD has only been investigated in younger adults and results are ambiguous. During life, serotonergic function changes, which can influence the indication and effectiveness of SSRIs in older adults with BPD. Aim of this study is to reach consensus on the suitability of SSRIs for the treatment of older adults with BPD.

METHODS: A Delphi study was conducted among eighteen international experts. In three successive rounds, a total of 16 statements addressing the treatment with SSRI's in older adults with BPD were assessed. Consensus on specific statements was reached if at least two-third of these experts agreed.

RESULTS: Consensus was reached on 11 statements related to the indication and effectiveness of SSRIs in the treatment of older adults with BPD.

CONCLUSION: The results of this study suggest a valuable role for SSRIs in the treatment of affective instability, and to a lesser extent impulsive behavior, in older adults with BPD. Sertraline or citalopram are suggested to be the first-choice medication but should be prescribed with some caution. Treatment recommendations have been suggested (presented in a flowchart), but still have to be investigated in clinical practice.

Keywords: Aged; Borderline personality disorder; Delphi technique; Drug therapy; Serotonin uptake inhibitors

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