The effect of IV ketamine in patients with major depressive disorder and elevated features of borderline personality disorder

Background: Comorbid borderline personality disorder and major depressive disorder is common and often not adequately responsive to standard antidepressant therapies. Ketamine is a potentially life-saving option.Methods: 153 adult patients with MDD were assessed with the Personality Assessment Inventory (PAI) Borderline Subscale. Data was normally distributed with a mean + SD of 38.95 + 11.54. Patients >1 SD above the mean were assigned to the MDD + BF group. All others were assigned to the MDD-BF group. Patients were admin-istered IV ketamine 0.5 mg/kg of ketamine over 40 min. Mood was assessed using the Beck Depression Inventory -II at baseline, 3 and 24 h post-ketamine. Scores between the MDD + BF and MDD-BF group at each time point were compared using t-test or analysis of covariance (ANCOVA) model. The primary outcome was response at 24 h.Results: The LS mean change in BDI at 24 h was-23.8 (15.3) for MDD + BF and-21.0 (13.5) for MDD-BF (F [1151] = 0.043, p = 0.51). The LS mean change in BDI at 3 h was-21.3 (13.2) for MDD + BF and-19.6 (13.2) for MDD-BF (F[1151] = 0.045, p = 0.83). The LS mean change in BDI at 14 days was-23.2 (15.3) for MDD + BF and-15.3 (15.2) for MDD-BF (F[1130] = 4.24, p = 0.04).Limitations: People in the MDD + BF group were not necessarily diagnosable with borderline personality disorder.Conclusions: These data indicate that IV ketamine is effective in MDD patients with and without elevated borderline features. This can provide clinicians some reassurance about using ketamine in this population.

Automated summary

This study suggests that intravenous ketamine is effective in patients with major depressive disorder, both with and without elevated borderline features. This provides reassurance for clinicians regarding the use of ketamine in this population.