Clonidine for hypernoradrenergic symptoms In patients with borderline personality disorder

Borderline Personality Disorder (BPD) and Posttraumatic Stress Disorder (PTSD) share clinical and psychogenetic traits so that BPD may be conceptualized as a complex PTSD. Several studies have provided compelling evidence for a central hypernoradrenergic activation in traumatized humans with PTSD by showing exaggeration of PTSD-symptoms by drugs increasing the central noradrenergic activity (1) and by studies showing efficacy of antinoradrenergic drugs for symptoms commonly associated with hypernoradrenergic activation such as hypervigilance, insomnia, nightmares and flash-backs (2,3). In an open case series of 5 patients with BPD we found that the antinoradrenergic agent clonidine improves hypernoradrenergic symptoms. Here we present preliminary data on a randomised, open-label, cross-over trial to test whether clonidine is beneficial in patients with BPD who experience prominent inner restlessness, sleep disturbances and nightmares. 1. Southwick SM et al.; Biol Psychiatry. 1999;1192–1204 2. Raskind MA et al.; Am J Psychiatry. 2003;371–373. 3. Friedman MJ; J Clin Psychiatry. 2000; Suppl 7:44–51.