78 BPD patients may be at increased risk for benzodiazepine dependence, in an effort to self-medicate chronic, refractory affective symptoms by fostering dissociative symptomatology. Targeting noradrenergic signaling has been less frequently studied in psychopharmacological treatment of BPD. The ocadrenergic agonist clonidine proved effective in treating comorbid post-traumatic

stress sellckchem disorder (PTSD) and BPD, but this effect selleck compound seemed specific to PTSD symptoms.114 Consistent with increasing Inhibitors,research,lifescience,medical recognition of omega-3 fatty acids in mood stabilization, one trial demonstrated tolerability and efficacy of omega-three ethyl-eicosapentaenoic acid (EPA) supplementation, decreasing aggression and affective symptoms in patients with moderate to severe Inhibitors,research,lifescience,medical BPD.43 Neuropeptides Recent psychopharmacological research in BPD has involved neuropeptides such as opioids and oxytocin, which modulate broadly-distributed neural networks associated with coordinating complex behavior. Other relevant neuropeptides include vasopressin and neuropeptide Y. Recent neurobiological research

has suggested endogenous opioid modulation as a potential avenue for treatment of BPD.115-116 Endogenous opioid signaling is involved in consummatory reward processing, pain modulation, social affiliation,117 rejection sensitivity, and maternal-infant attachment,118-119 which may have implications for impulsivity, Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical self-injurious behavior, and interpersonal dysfunction in BPD. Dysregulated opioid signaling is also associated with affective instability in BPD.120 Despite promise in terms of potential implications in the developmental psychopathology of BPD, opioid medications have not demonstrated consistent

therapeutic benefit. An early open-label study of the opioid antagonist naltrexone showed early promise in treating dissociative symptoms in BPD.121 Stabilization of opioid signaling Inhibitors,research,lifescience,medical may improve self-injury, dissociation, impulsivity, and interpersonal functioning.115-116 Moreover, opioid antagonism may prevent adverse effects of dissociation on behavioral conditioning,122 suggesting a potential synergistic role with psychotherapy to improve interpersonal hypersensitivity. Nevertheless, both opioid agonists123,124 Brefeldin_A and antagonists125 have shown limited efficacy in preliminary research with BPD patients. A more recent, placebo-controlled trial of naltrexone also failed to demonstrate statistically significant improvement in dissociative symptoms.126 Therefore, opioid medications lack clear role in treating BPD, and they are associated with substantial risks of dependence (primarily for agonists) and other potential adverse effects. Oxytocin is associated with empathic processing, self-similarity evaluation, attuned parental care-giving, and affiliative bonding.127-129 This has led to similar considerations for treating interpersonal dysfunction in BPD.