1. ¹Leiden University Medical Center, Department of Psychiatry, Netherlands
2. ²Leiden/Amsterdam Center for Drug Research, Leiden University Medical Center, Division of Medical Pharmacology, Netherlands
3. ³Department of Psychiatry, Academic Medical Center, University of Amsterdam, Netherlands
4. ⁴Rijngeestgroep, Oegstgeest, and Leiden, University Medical Centre, Department of Psychiatry, Netherlands
5. ⁵Laboratorium, Rijngeestgroep, Oegstgeest, Netherlands
6. ⁶Department of Psychiatry, Academic Medical Center, University of Amsterdam, Netherlands

Correspondence: Thomas Rinne, Leiden University Medical Center, Department of Psychiatry, P.O. Box 9600, 2300 RC Leiden, Netherlands. Tel: +31 71 5263448; Fax: +31 71 5248156; E-mail: rinne@euronet.nl, t.rinne@LUMC.nl

Received 14 November 2001; Revised 21  2002; Accepted 1  2002.

Abstract

The aim of the study is to test whether fluvoxamine affects the function of the hypothalamic pituitary adrenal (HPA) axis in female borderline (borderline personality disorder, BPD) patients with and without a history of sustained childhood abuse. Special attention is given to the presence of comorbid major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The HPA axis of 30 female BPD patients with (n=17) and without (n=13) a history of sustained childhood abuse was challenged with a combined dexamethasone and corticotropin releasing hormone test (DEX/CRH test) before and after 6 (n=14) and 12 (n=16) weeks of fluvoxamine treatment (150 mg/day). Both 6- and 12-week fluvoxamine treatments were associated with a significant and robust reduction of the adrenocorticotrophic hormone (ACTH) and cortisol response to the DEX/CRH test. The magnitude of the reduction was dependent on the presence of sustained childhood abuse, but not on the presence of comorbid MDD or PTSD: patients with a history of sustained childhood abuse showed the strongest reduction in ACTH and cortisol. In conclusion, Fluvoxamine treatment reduces the hyperresponsiveness of the HPA axis in BPD patients with a history of sustained childhood abuse. This effect is likely to be obtained in the first 6 weeks of treatment.