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Borderline personality disorder delayed MDD remission, accelerated relapse

Treatment of borderline personality disorder should be prioritized due to possible overlaps with major depressive disorder psychopathology, according to recent study findings published in The Journal of Clinical Psychiatry.

John G. Gunderson, MD, of McLean Hospital in Belmont, Mass., and colleagues evaluated 223 people (mean age, 32.1 years) with borderline personality disorder (BPD) and DSM-IV-defined co-occurring major depressive disorder (MDD; n=161), bipolar I disorder (n=34), and bipolar II disorder (n=28) to determine the interactions between the disorders. Data were evaluated from 1997 to 2009.

John G. Gunderson

Time to remission for MDD was negatively affected by BPD (P=.0004) and time to MDD relapse was accelerated by BPD (P=.041). However, BPD did not significantly affect time to remission or relapse for bipolar I or bipolar II episodes.

BPD time to remission was delayed (P=.0002) and time to relapse was accelerated (P=.0011) by MDD. However, bipolar I and bipolar II episodes did not significantly affect BPD.

“Despite the overlap in phenomenology, but consistent with other research, BPD and bipolar disorder appear to be surprisingly independent disorders,” Gunderson told Healio.com. “This means each requires its own treatment; ie, treatment of either is unlikely to have much effect on the other. In contrast, BPD and MDD each has significantly negative effects on each other’s course. Here the treatment of BPD take priority, not only because its remission will be followed by remission of MDD, but also because when MDD co-occurs with BPD, it is unlikely to respond to antidepressant medications.” — by Amber Cox

John G. Gunderson, MD, can be reached at 115 Mill Street, Belmont, M.A. 02478; email: jgundersoN@mclean.harvard.edu.

Disclosure: The study was funded in part by the National Institute of Mental Health and the Veterans Affairs Medical Center, Providence, R.I.