Real world effectiveness of repeated ketamine infusions for treatment-resistant depression with comorbid borderline personality disorder. (May 2023)

• Record Type: Journal Article
• Authors: Danayan, Kevork; Chisamore, Noah; Rodrigues, Nelson B.; Vincenzo, Joshua D. Di; Meshkat, Shakila; Doyle, Zoe; Mansur, Rodrigo; Phan, Lee; Fancy, Farhan; Chau, Edmond; Tabassum, Aniqa; Kratiuk, Kevin; Arekapudi, Anil; Teopiz, Kayla M.; McIntyre, Roger S.; Rosenblat, Joshua D.
• Is Part Of: Psychiatry research. Volume 323(2023)
• Publication Date: 2023-05
• Subjects: Ketamine -- Treatment resistant depression -- Borderline personality disorder -- Comorbidity -- Major depressive disorder -- Bipolar disorder -- Esketamine -- Emotionally unstable personality disorder -- Cluster B Traits; Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2023.115133
• Languages: English
• ISSNs: 0165-1781

Abstract

Highlights: Comorbidity of borderline personality disorder (BPD) with depression is common. Comorbid BPD is often associated with poorer response to antidepressants. Ketamine was as effective for the BPD-positive sample as it was for participants without BPD. BPD was not associated with poorer response to ketamine. Ketamine was associated with improvements in core symptoms of BPD. Abstract: Borderline personality disorder (BPD) has high rates of comorbidity with mood disorders, including treatment-resistant depression (TRD). Comorbidity of BPD with depression is associated with poorer response to antidepressants. Intravenous ketamine is a novel treatment for TRD that has not been specifically evaluated in patients with comorbid BPD. In this retrospective analysis of data collected from participants who received care at the Canadian Rapid Treatment Centre of Excellence (CRTCE; Braxia Health; ClinicalTrials.gov: NCT04209296), we evaluated the effectiveness of intravenous ketamine in a TRD population with comorbid BPD ( N =100; n =50 BPD-positive compared with n =50 BPD-negative). Participants were administered four doses of intravenous ketamine (0.5-0.75mg/kg over 40 minutes) over two weeks. The primary outcome measures were changes in depressive symptom severity (as measured by Quick Inventory of Depressive Symptomatology–Self Report 16-item (QIDS-SR16 )) and borderline symptom severity (as measured by Borderline Symptom List 23-item (BSL-23)). Both BPD-positive and BPD-negative groups improved significantly on the QIDS-SR16, QIDS-SR16 suicide ideation item, anxiety, and functionality scales with large effect sizes. There was no significant difference between groups. The BPD-positive group exhibited significant reduction of 0.64 on BSL-23 scores and a significant reduction of 5.95 on QIDS-SR16 scores. Patients with TRD and comorbid BPD receiving ketamine exhibited a significant reduction in symptoms of depression, borderline personality, suicidality, and anxiety.