A Comparison of Fluoxetine (Prozac) and Sertraline (Zoloft) in Treating Four Target Symptoms of the Borderline Personality Disorder

Written by Dr. Leland Heller

1713 US Hwy 441 N, Suite E
Okeechobee, FL 34972
(863) 467-8771
copyright February 1994

ACKNOWLEDGMENTS:

This study was supported financially by a $2500 Education Grant by Pfizer, Inc., manufacturer of sertraline. To the best of my knowledge, I was not given a grant number.

STATISTICAL SIGNIFICANCE:

Due to the small number of patients studied, no statistical analyses (such as p values) are included. The number of patients is not statistically significant.

ABSTRACT

BACKGROUND:

Little is known about which specific Borderline Personality Disorder symptoms are affected by SSRI's, and how different medications in the SSRI class compare inn treating the Borderline Personality Disorder. This study compares the effects of fluoxetine with sertraline on four target symptoms: mood swings, chronic anger, emptiness/boredom, and chronic emotional pain.

METHODS:

Four patients were switched from fluoxetine to sertraline. Five patients who had never taken fluoxetine were given a trial of sertraline.

RESULTS:

Those switched from fluoxetine to sertraline experienced worsening of their symptoms and returned to taking fluoxetine. For those who had not previously taken fluoxetine, sertraline was extremely effective for some, mildly effective for others.

CONCLUSIONS:

Both fluoxetine and sertraline are effective in reducing mood swings, chronic anger, emptiness and boredom, emotional pain, and depression. Fluoxetine appears to be superior.

TEXT

Studies by Norden (1), Markovitz (2), Cornelius (3), and Hull (4) have shown efficacy in treating Borderline Personality Disorder (BPD) patients with fluoxetine.

In my practice, I have over 400 patients. Four symptoms are significantly reduced by fluoxetine: mood swings, chronic anger, emptiness/boredom, and chronic emotional pain (5).

Sertraline is a new SSRI. This study's purpose is to compare it's efficacy to fluoxetine. Four patients successfully treated with fluoxetine were switched to sertraline. Six patients who had never taken fluoxetine began treatment with sertraline, five completed the study.

METHODS

All patients were diagnosed by reviewing the DSM-III-R criteria, carefully emphasizing that this was a lifetime pattern, affecting virtually every aspect of their lives. Those experiencing chronic dysphoria (6), incest crisis, or significant dissociative symptoms were excluded from the study.

Baseline laboratory testing, physical examinations and Zung depression tests were performed.

Patients also filled out a symptoms questionnaire. They rated each symptom as "no problem" which equals a score of 1, "mild problem" - score of 2, "moderately severe" - score of 3, and "very severe" - score of 4. During subsequent visits, they also rated the percentage of symptom relief. This was an exclusively patient rated study.

Mood swings were defined as "inappropriate mood changes, not directly related to life's events."

Chronic anger was defined as "feeling angry most or all of the time. This chronic anger is not to be confused with the uncontrollable rage a borderline personality disorder patient sometimes experiences."

Emptiness/boredom was defined as "Emptiness is a sensation of feeling empty inside. The boredom is not due to boring life situations, but presents itself in virtually all life situations, including pleasant ones."

Emotional pain was defined as "feeling like your best friend or close relative died."

All patients previously treated with fluoxetine had a wash out period - two for 7 days, one 30 days, one 120 days. Each experienced the period off fluoxetine as very unpleasant.

Patients were begun on 50 mg of sertraline daily, and re-evaluated regularly, either weekly or monthly. If symptom improvement was inadequate, the dose was increased, up to a maximum of 200 mg of sertraline daily. A Zung index and symptom assessment were completed at every visit.

Office visits, the physical examination, laboratory tests, and medication were free to the patient during the study period.