In the early 1970s, when studies on borderline patients began in earnest, most inpatients received either an inadequate trial on any psychotropic drug or none at all. The literature of that period warned about the ineffectiveness1,2 or actual harmfulness3-7 of pharmacologic treatment for borderline patients.
A decade later, it had become rare for any inpatient with borderline personality disorder to be discharged without a vigorous trial of at least one psychotropic agent. Even in outpatient settings, the majority of patients had prior exposure to psychotropic medications.8 This proliferation of drug treatments for borderline patients had taken place despite the absence of any controlled evaluations. In fact, the additions to the literature largely consisted of case series from which claims were made for the usefulness of monoamine oxidase inhibitors,9 tricyclic antidepressants,10 and low-dose phenothiazines.11 The greatly expanded awareness of the potential value of such pharmacotherapies