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Depressed Patients with Comorbid Borderline Personality Disorder: Does ECT Work?

These patients had poorer response to ECT than depressed patients with other personality disorders.

It has been estimated that 30% to 80% of patients with major depressive disorder (MDD) will be diagnosed with a comorbid personality disorder during their lifetimes, and as many as 50% of patients with borderline personality disorder (BPD) will experience MDD at some point. Further, MDD patients with personality disorders often fail to respond to common pharmacologic treatments for MDD, or they suffer frequent relapses. Thus, psychiatrists often consider ECT as a treatment option. To examine the relative effectiveness of ECT for treating depression in patients with BPD, investigators examined study data of 139 patients with major depression who were receiving ECT.

Twenty patients had BPD, 42 had other personality disorders, and 77 had no diagnosed personality disorder (mean number of ECT treatments, 10.5, 11.8, and 11.6, respectively). Only 22.2% of the BPD patients were assessed as clinically remitted 4 to 8 days after the last ECT treatment, in contrast to remission in 55.6% of those with other personality disorders and 71.7% of those with no personality disorder. Patients with more severe dimensional ratings of BPD were less likely to respond to ECT. Although BPD patients were more likely than patients in the other groups to be female, to be younger, and to have medication-resistant conditions, statistical analyses suggested that these factors did not account for differences in response.

Comment: This small-scale, short-term study merits replication and extension beyond the immediate post-ECT period. Exactly which aspects of BPD affect treatment response requires elucidation. Poor ECT response in some BPD patients may result from their severe depressive syndromes being categorically distinct from the usual ECT-responsive forms of major depressive disorder. Knowing that more-severe BPD symptoms predict diminished likelihood of response may help clinicians better select patients for ECT.

— Joel Yager, MD

Published in Journal Watch Psychiatry December 8, 2004

Citation(s):

Feske U et al. Clinical outcome of ECT in patients with major depression and comorbid borderline personality disorder. Am J Psychiatry 2004 Nov; 161:2073-80.

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