Electroconvulsive Therapy Effective for Patients With Major Depression, Comorbid Borderline Personality Disorder: Presented at APA

By Michael Schreiber, PhD

NEW YORK -- May 15, 2018 -- Patients receiving electroconvulsive therapy (ECT) for major depressive disorder (MDD) benefit equally whether or not they also have borderline personality disorder (BPD), according to a study presented here at the 2018 Annual Meeting of the American Psychiatric Association (APA).

James Lee, Mayo Clinic, Rochester, Minnesota, and colleagues performed a retrospective chart review that included data from 137 adult inpatients admitted to a mood disorders unit and were diagnosed with severe primary unipolar depression and who completed the McLean Screening Instrument for BPD (MSI-BPD) prior to treatment with ECT. A total of 29 patients screened positive for BPD.

The researchers collected Patient Health Questionnaire (PHQ)-9 scores before and after ECT and compared scores between patients with and without BPD.

Contrary to expectations based on previous research, ECT improved symptoms of MDD equally in patients with and without BPD. For patients with BPD, PHQ-9 scores declined from a mean of 22.31 to a mean of 7.93 following ECT. For those without BPD, mean PHQ-9 scores declined from 19.89 to 7.01 following ECT.

At 1 month post-treatment, PHQ-9 scores were not significantly different between patients with and without BPD who were treated with ECT (P = .19), suggesting that rates of MDD recurrence may be similar between these groups.

Based on the results, the authors said that ECT need not necessarily be withheld from patients with MDD and comorbid BPD. However, the study was limited by its single-institution, retrospective design and use of screening instruments to establish presence of BPD.

Previous literature has suggested that ECT is not as effective in the treatment of MDD in the presence of comorbid BPD, but Lee and colleagues stressed that patient selection is important in treating BPD with ECT and suggest that ECT may be more appropriate for patients with severe, neurovegetative depression.

[Presentation title: Use of Electroconvulsive Therapy in Patients With Major Depression and a Comorbid Borderline Personality Disorder. Abstract P4-152]

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