Long-Term Course of Major Depression Similar in Borderline, Other Personality Disorders

Prevalence rates of major depressive disorder in patients with borderline personality disorder are higher than those reported by patients with other personality disorders; however, rates of remissions, recurrences, and new onsets were similar in both groups.

The long-term course of major depression was similar in patients with borderline personality disorder (BPD) and patients with other personality disorders (OPD), according to data published in the Journal of Affective Disorders.

The McLean Study of Adult Development began enrolling adults with personality disorders in 1992; 12 contiguous follow-up waves were conducted every 24 months until 2018. All patients were administered the Structured Clinical Interview for DSM-III-R Axis I Disorders at baseline and at every follow-up visit. Remission was defined as any 2-year period in which criteria for major depression were no longer met; recurrence described any 2-week period in which the criteria for major depression were met after a 2-year remission. The generalized estimating equations approach was used to assess the prevalence rate of depression over 24 years of follow-up. Kaplan-Meier curves were used to capture time-to-remission, time-to-recurrence, and time-to-new-onset; Cox proportional hazard models were used to assess between-group differences in these patterns. 

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A total of 290 patients with BPD and 72 patients with OPD completed a baseline Structured Clinical Interview. Rates of continuing participation were comparable between groups, with 82% of the surviving BPD group and 79% of the surviving OPD group completing all 12 follow-up interviews.  The average (standard deviation) age at index date was 27 (6.3) years; 77.1% were women; 87% were white. The prevalence rate of major depression was significantly higher in the BPD group than the OPD group over time (P <.001). However, prevalence rates declined significantly over time in both groups, for a cumulative reduction of 49%. The patterns of remission, recurrence, and new onset were not significantly different between groups. The majority (93%) of patients with BPD and 100% of patients with OPD achieved a 2-year remission during follow-up. In addition, 90% of the BPD group and 89% of the OPD group experienced a recurrence of major depression over the study course. In patients with no major depression at baseline, new onset was observed in 86% and 78% of patients with BPD and OPD, respectively.

Enrollment was limited to psychiatric inpatients, 90% of whom were in individual therapy and using psychotropic medications at baseline. As such, the results may not be applicable to patients with BPD who are not currently in treatment. Even so, data on the long-term course of depression in BPD may be useful to clinicians. “The remitting-recurring course of major depression in [BPD] is very similar to the course observed among patients with other types of personality disorder and those for whom major depression is their primary diagnosis,” the investigators concluded.


Zanarini MC, Hörz-Sagstetter S, Temes CM, et al. The 24-year course of major depression in patients with borderline personality disorder and personality-disordered comparison subjects [published online August 3, 2019]. J Affect Disord. doi:10.1016/j.jad.2019.08.005