Determining the Impact of Borderline Personality Disorder in the Treatment Outcome of Depression

Aim: To evaluate whether Borderline Personality Disorder (BPD) has an impact on the treatment outcome in patients with Major Depressive Disorder (MDD).

Methods: We studied 130 patients who met the DSM-IV criteria for MDD according to the DSM-IV checklist. Patients were assessed for depression and BPD using the Montgomery Asberg Depression Rating Scale (MADRS) and the Structured Clinical Interview for DSM-IV Personality Disorders (SIDP-IV), respectively. Each patient was assessed for depression severity using the MADRS score at the beginning of the study and once again after 8-12 weeks of Selective Serotonin Reuptake Inhibitor (SSRI) treatment. Results derived from MADRS evaluations of patients with MDD comorbid with BPD (MDD+BPD) were analyzed and compared with results from patients with MDD no comorbid BPD (MDDnoBPD). The rates of remission and response to treatment in these two groups were thereby measured and compared.

Results: Patients with MDD+BPD had statistically significantly lower rates of remission after SSRI treatment compared to patients with MDDnoBPD (P= .009). Interestingly, when comparing patients that had single episode of MDD, the difference in remission rates was not statistically significant (P= .07) in both groups. In contrast, when comparing patients with recurrent episode of MDD, remission rates were statistically significantly lower in patients with MDD+BPD (P= .03).

Conclusion: MDD+BPD patients have lower rates of remission when treated with SSRIs in comparison with MDDnoBPD. Therefore, it is important to assess MDD patients for additional personality disorders in order to structure an optimal treatment plan with clear prognostic indicators.