Is it possible that a dysfunctional opioid system is responsible for some of the more serious symptoms in Borderline Personality Disorder?
One of the most common complaints in B.PD is dysphoria, which is frequently relieved by self-harm. Agonism of the KOR is known to induce dysphoria and dissociation, both symptoms common in B.PD. Self-harm aggravates the production of endogenous opioids that target the MOR among others, but may suppress KOR agonism or antagonize the KOR.
B.PD historically has not responded well to pharmacological intervention, including B.PD depressive symptoms being resistant to SSRIs and MAOIs, but there is emerging evidence that it may show response to opioid antagonists, and that the more pronounced effects are seen after administration of antagonists that more potently target the KOR.
Also, KOR antagonism has shown potential to relieve the dysphoria associated with opiate withdrawal, and those with B.PD are disproportionately represented in opiate addicts presenting clinically. Is it possible they are self-medicating with selective MOR agonists to suppress KOR agonism? They commonly report feeling euthymic rather than euphoric after opiate abuse.
There are no KOR antagonists prescribed in psychiatry AFAIK, but there are experimental highly selective KOR antagonists. Perhaps they warrant investigation in B.PD?
One of the most common complaints in B.PD is dysphoria, which is frequently relieved by self-harm. Agonism of the KOR is known to induce dysphoria and dissociation, both symptoms common in B.PD. Self-harm aggravates the production of endogenous opioids that target the MOR among others, but may suppress KOR agonism or antagonize the KOR.
B.PD historically has not responded well to pharmacological intervention, including B.PD depressive symptoms being resistant to SSRIs and MAOIs, but there is emerging evidence that it may show response to opioid antagonists, and that the more pronounced effects are seen after administration of antagonists that more potently target the KOR.
Also, KOR antagonism has shown potential to relieve the dysphoria associated with opiate withdrawal, and those with B.PD are disproportionately represented in opiate addicts presenting clinically. Is it possible they are self-medicating with selective MOR agonists to suppress KOR agonism? They commonly report feeling euthymic rather than euphoric after opiate abuse.
There are no KOR antagonists prescribed in psychiatry AFAIK, but there are experimental highly selective KOR antagonists. Perhaps they warrant investigation in B.PD?
