People with relatively severe borderline personality disorder symptoms may actually have better chances of responding to treatment based on a combination of psychotherapy and medication, according to recent evidence from a team of Italian researchers. Doctors commonly treat symptoms of the serious mental health condition borderline personality disorder (BPD) with some form of non-medication-based psychotherapy. However, BPD treatment may also include medication use. In a study published in January 2015 in the journal Psychiatry Research, researchers from Italy\u2019s University of Turin sought to determine which borderline personality disorder patients respond best to the combined use of a form of psychotherapy called interpersonal therapy and a medication called fluoxetine (Prozac, Rapiflux). The researchers concluded that people with especially severe BPD symptoms may respond best to this combined therapy.\r\nInterpersonal Therapy and BPD\r\nForms of psychotherapy most typically used to address borderline personality disorder\u2019s classic emotion-destabilizing effects include dialectical behavior therapy and schema-focused therapy, two approaches that help affected individuals improve their ability to recognize dysfunctional emotional responses and develop new emotional responses that support everyday function and well-being. Doctors also sometimes use an approach called interpersonal therapy or interpersonal psychotherapy (IPT). During this form of treatment, therapists take steps to increase their clients\u2019\/patients\u2019 ability to communicate effectively in the back-and-forth exchanges that characterize social interactions. IPT practitioners rely on improvement of interpersonal function as a pathway to relieving the underlying emotional\/psychological distress that commonly forms a core element of serious mental illness. IPT has been shown to provide a significant treatment benefit for people affected by borderline personality disorder. However, the therapy does not sufficiently address all possible BPD symptoms. For this reason, doctors typically combine interpersonal psychotherapy with medication. The most common option in this context is any medication that belongs to a class of antidepressants called SSRIs or selective serotonin reuptake inhibitors. In addition to fluoxetine, examples of SSRI medications include sertraline (Zoloft), fluvoxamine (Luvox CR), escitalopram (Lexapro) and paroxetine (Pexeva, Paxil).\r\nFluoxetine\r\nLike all SSRIs, fluoxetine produces its beneficial effects by boosting the brain\u2019s levels of an important mood-controlling chemical called serotonin. Generally speaking, when serotonin levels in the brain fall, the ability to control mood fluctuations also falls. Conversely, when serotonin levels in the brain rise, the ability to control mood fluctuations also rises. Doctors most typically use fluoxetine as a treatment for major depression or other forms of depressive illness like premenstrual dysphoric disorder, as well as for an anxiety-based condition called panic disorder, obsessive-compulsive disorder (OCD) and certain forms of eating disorder. In addition to BPD treatment, other potential uses of the medication include post-traumatic stress disorder (PTSD) treatment, alcohol use disorder (alcoholism\/alcohol abuse) treatment and treatment of an anxiety-based condition called specific phobia.\r\nWhat Predicts Successful Combined BPD Treatment?\r\nIn the study published in Psychiatry Research, the University of Turin researchers used a small-scale project to help determine which individuals have the best chances of responding to a BPD treatment regimen that combines interpersonal psychotherapy with fluoxetine. Twenty-seven of the project\u2019s participants received a form of IPT specifically reworked for people with borderline personality disorder, as well as daily doses of fluoxetine ranging from 20 mg to 40 mg. This combined treatment lasted for eight months. At the beginning of treatment and the end of treatment, each participant had his or her BPD-related symptoms assessed with screening tools that included that Clinical Global Impression \u2013 Severity scale (CGI-S), the Borderline Personality Disorder Severity Index (BPDSI), the Hamilton Rating Scale for Anxiety (HAM-A\/HARS) and the Satisfaction Profile (SAT-P). After analyzing the outcomes of the various screening tools, the researchers concluded that the most important indicator of who benefits from combined IPT\/fluoxetine treatment appears to be the Clinical Global Impression \u2013 Severity scale, which helps doctors identify the severity of BPD symptoms in any given individual. Outcomes of the Borderline Personality Disorder Severity Index also help predict treatment success. Crucially, people heavily affected by borderline personality disorder seem to benefit more from the combined use of interpersonal therapy and fluoxetine than people with less severe forms of the condition. Specific major symptoms that point toward an improved treatment outcome include heightened levels of mood instability, extreme real or imagined fears of abandonment by others and a prominent inability to develop a consistent sense of self. The researchers note that the benefits of combined IPT\/fluoxetine treatment appear without respect to depression or anxiety, two conditions often found in people with BPD.