Depression with comorbid borderline personality disorder – could ketamine be a treatment catalyst?

Summary & key facts

Borderline personality disorder often happens together with major depression. The authors looked at the small number of studies and case reports that used ketamine for people who have both depression and borderline personality problems. They explain how ketamine might change the brain in ways that could reduce core borderline symptoms, and they raise the idea that combining ketamine with psychotherapy could make effects last longer. But the evidence is limited, there are no agreed rules for using ketamine in this group, and more research is urgently needed to know who might benefit and how to do it safely.

Key facts:

• Between about 10% and 30% of people diagnosed with major depression also have borderline personality disorder.
• More than 80% of people with borderline personality disorder will have major depression at some point.
• When someone has both depression and borderline personality disorder, their depression tends to be worse, they have more trouble functioning, and they face a higher chance of not responding to usual treatments and of suicidal thoughts or actions.
• Many studies have shown that ketamine can help people with depression that does not get better with usual treatments, but most of those studies did not exclude people with borderline personality disorder.
• Because most ketamine studies included people with borderline traits, it is possible that ketamine also helps people who have both treatment-resistant depression and borderline personality disorder, but the evidence for that specific group is small.
• The authors describe biological reasons why ketamine might affect borderline symptoms, such as changing the brain’s wiring or chemistry in ways that could reduce emotional instability and self-harm urges.
• The paper suggests that combining ketamine with psychotherapy could take advantage of the brain changes ketamine causes to produce longer-lasting benefits, but this idea has not been tested in standard clinical protocols.
• There are currently no standard treatment plans for giving ketamine or ketamine-assisted therapy to people who have both treatment-resistant depression and borderline personality disorder.
• The authors call for more research to build clear protocols, find which subgroups might benefit most, and study safety and factors that affect how well the treatment works.

Abstract

Borderline personality disorder (BPD) is diagnosed in 10-30% of patients with major depressive disorder (MDD), and the frequency of MDD among individuals with BPD reaches over 80%. The comorbidity of MDD and BPD is associated with more severe depressive symptoms and functional impairment, higher risk of treatment resistance and increased suicidality. The effectiveness of ketamine usage in treatment resistant depression (TRD) has been demonstrated in numerous studies. In most of these studies, individuals with BPD were not excluded, thus given the high co-occurrence of these disorders, it is possible that the beneficial effects of ketamine also extend to the subpopulation with comorbid TRD and BPD. However, no protocols were developed that would account for comorbidity. Moreover, psychotherapeutic interventions, which may be crucial for achieving a lasting therapeutic effect in TRD and BPD comorbidity, were not included. In the article, we discuss the results of a small number of existing studies and case reports on the use of ketamine in depressive disorders with comorbid BPD. We elucidate how, at the molecular and brain network levels, ketamine can impact the neurobiology and symptoms of BPD. Furthermore, we explore whether ketamine-induced neuroplasticity, augmented by psychotherapy, could be of use in alleviating core BPD-related symptoms such as emotional dysregulation, self-identity disturbances and self-harming behaviors. We also discuss the potential of ketamine-assisted psychotherapy (KAP) in BPD treatment. As there is no standard approach to the application of ketamine or KAP in individuals with comorbid TRD and BPD, we consider further research in the field as imperative. The priorities should include development of dedicated protocols, distinguishing subpopulations that may benefit most from such treatment and investigating factors that may influence its effectiveness and safety.

Topics

Mental Health Research Topics Treatment of Major Depression Tryptophan and brain disorders

Categories

Health Sciences Medicine Pharmacology

Tags

Borderline personality disorder Clinical psychology Comorbidity Depression (economics) Economics Ketamine Macroeconomics Major depressive disorder Mood Psychiatry Psychological intervention Psychology Schizophrenia (object-oriented programming) Treatment-resistant depression

Substances

Ketamine

Conditions & symptoms

Depression Feeling disconnected from others Lack of energy or motivation Sadness or low mood