Selective Serotonin Reuptake-Inhibitors for Symptom-Based Treatment of Borderline Personality Disorders in Older Adults; an International Delphi Study
Julie Schulkens 1, 2*, Nina Bergs 3, Theo Ingenhoven 4, Erlene Rosowsky 5, 6, Sebastiaan van Alphen 1, 7, 8, Sjacko Sobczak 1, 2
1Clinical Center of Excellence for Personality Disorders in Older Adults, 2School for Mental Health and Neuroscience (MHeNs), department of Psychiatry and Neuropsychology Maastricht University Medical Centre+, 3Maastricht University Faculty of Health Medicine and Life Sciences , 4NPI Center for Personality Disorders, Arkin Mental Healthcare , 5William James College, Department of Clinical Psychology, 6Harvard Medical School, Department of Psychiatry , 7Vrije Universiteit Brussel, Department of Clinical and Life Span Psychology, 8Tilburg University, Department of Medical and Clinical Psychology
Received: June 8, 2020; Revised: August 3, 2020; Accepted: August 5, 2020; Published online: August 5, 2020.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Introduction: 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.
Objectives: 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: delphi method, older adults, borderline personality disorder, SSRI, pharmacotherapy


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