Single-dose effects of Citalopram on neural responses to affective stimuli in borderline personality disorder: A randomized clinical trial.

Abstract

BACKGROUND\nPsychiatric medication that has a soothing effect on the limbic responses to affective stimuli could improve affective instability symptoms as observed in Borderline Personality Disorder (BPD). The objective of this study was to investigate whether Citalopram vs. Placebo reduces the response of the affective neural circuitry during emotional challenge.\n\n\nMETHODS\nN=30 femaie individuals with BPD diagnosis participated in a Placebo-controlled, double-blind crossover trial design. Three hours after oral drug intake, individuals with BPD viewed affective pictures while undergoing functional Magnetic Resonance Imaging. Blood Oxygenation Level Dependent responses to images of negative affective scenes and faces showing negative emotional expressions were assessed in regions-of-interest (amygdala, anterior cingulate cortex, anterior insula, dorsolateral prefrontal cortex). Blood perfusion at rest was assessed with arterial spin labeling.\n\n\nRESULTS\nThe neural response to pictures showing negative affective scenes was not significantly affected by Citalopram (N=23). Citalopram significantly reduced the amygdala response to pictures of faces with negative affective expressions (N=25, treatment difference left hemisphere: -0.06 ±0.16, P<0.05, right hemisphere: -0.06±0.17, P<0.05). We observed no significant effects of Citalopram on the other regions. The drug did not significantly alter blood perfusion at rest.\n\n\nCONCLUSIONS\nCitalopram can alter the amygdala response to affective stimuli in BPD, which is characterized by overly responsive affective neural circuitry.