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No. 1 (2025)

GENERAL THERAPY QUESTIONS AND REVIEWS

The Use of Opioid Antagonists in the Treatment of Patients with Borderline Personality Disorder: Linking mechanisms of Action to Inflammation and metabolic Effects

https://doi.org/10.48612/psyph/r1vh-verr-fgkp

Published 2025-03-30

  • A.R. Protasov
    • ,
  • G.V. Rukavishnikov
    • ,
  • G.E. Mazo

A.R. Protasov
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology of the Ministry of Heath of the Russian Federation

G.V. Rukavishnikov
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology of the Ministry of Heath of the Russian Federation

G.E. Mazo
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology of the Ministry of Heath of the Russian Federation

Abstract

Currently, the use of most psychopharmacological treatments for borderline personality disorder (BPD) has not been shown to be effective based on evidence. The current hypothesis regarding the dysfunction of the endogenous opioid system in BPD has led researchers to believe that opioid antagonists may be able to alleviate some of the symptoms of this condition. This review analyzes the available literature that investigates the effect of opioid antagonists in BPD. A search was conducted for open access articles published in Russian and English. The queries included the names of currently registered drugs that are full or partial antagonists of opioid receptors. Eleven works meeting the search criteria were identified, consisting of placebo-controlled studies, including randomized (n = 2), longitudinal (n = 3), and retrospective studies (n = 1), as well as clinical case reports (n = 4). The majority of studies used naltrexone (n = 6). The only study that used naloxone did not find a beneficial effect on BPD symptoms. Data obtained from other studies suggest that the administration of medications from this group may be effective in treating certain symptoms, including non-suicidal self-injury, impulsivity, suicidal tendencies and dissociative symptoms. The article also discusses the possible effects of opioid system impairment on other endocrine systems, including metabolic effects and systemic inflammation. The research also suggests that one of the main factors in the development of this disorder is not only the endogenous opioid system as a whole, but also the availability of dynorphin and kappa opioid receptors. These receptors affect the activity of dopamine neurons and thus influence hedonic thresholds and positive and negative reinforcement mechanisms, which may explain many BPD symptoms. Further research in this area may lead to the development of new, pathogenetically based approaches to the treatment of BPD.

Keywords

borderline personality disorder, pharmacotherapy, endogenous opioid system, opioid antagonists, metabolic disorders, inflammatory process

PDF (Русский)

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