Borderline Personality Disorder (BPD) with comorbid Major Depressive Disorder (MDD) may be difficult to treat; however, a systematic review found that selective serotonin reuptake inhibitors (SSRI) with psychotherapy may be the best treatment combination. These findings were published in the Journal of Affective Disorders.
Publication databases were searched through April 2020 for papers researching MMD with BPD. The 13 selected papers were longitudinal (n=11), retrospective (n=1), and case report (n=1) studies published between 1994 and 2014. The studies focused on pharmacotherapy, bright light therapy, psychotherapy, or electro-convulsive therapy (ECT).
Studies with pharmacotherapy treatments which had positive results included the reduction of BPD diagnoses following sertraline (P <.01), citalopram (P <.001), or 20 mg/day fluoxetine (P <.0001) therapies. A study found a significant interaction between the reduction of depression symptoms and degree change of BPD criteria following fluoxetine therapy (P <.0001).
Few studies that focused on pharmacotherapies in combination with other therapy types observed significant responses, except for 1 study which observed a decrease of depressive symptoms among patients receiving SSRI with psychotherapy (P <.001) and also a significant increase of emotional intelligence over time.
ECT was observed to be less effective among patients with comorbid BPD and MDD than patients with MDD alone (P <.001) and patients with comorbid conditions were less likely to achieve remission (P =.991) following ECT. Conversely, another study did observe a reduction of depression symptoms among patients with MDD and BPD following ECT (P <.0001), but the response was dependent on the number of ECT sessions (P =.004).
Among studies with no specifically tested therapeutic, rates of MDD remission were found to be significantly reduced among patients with comorbid BPD (P =.0001) but MDD had no significant effect on BPD remission (P =.79). In the case of reduced BPD symptoms, MDD remission was predicted (P =.0012).
Of the borderline criteria, emptiness (P <.0001), affective instability (P <.0001), anger (P =.0035), brief psychotic episodes (P =.0004), and self-injury (P =.0008) were correlated with MDD remission.
This study was likely limited by the underlying studies, many of which had no control component or standardized treatments and some had small sample sizes.
These findings indicated BPD negatively affected the clinical trajectory of MDD, but that SSRI in combination with psychotherapy may be the best treatment option for these patients.
Ceresa A, Esposito CM, Buoli M. How does borderline personality disorder affect management and treatment response of patients with major depressive disorder? A comprehensive review. J Affect Disord. Published online November 21, 2020. doi:10.1016/j.jad.2020.11.111