Borderline personality disorder in major depression: symptomatology, temperament, character, differential drug response, and 6-month outcome.
Among 183 depressed patients participating in a randomized long-term treatment trial of fluoxetine and nortriptyline, 30 patients had borderline personality disorder (BPD), 53 had other personality disorders (OPD), and 100 had no personality disorders (NPD). The borderline depressed patients had earlier age of onset of their depressions, more chronic depressions, more alcohol and cannabis comorbidity, and were more likely to have histories of suicide attempts and of self-mutilation. On self-report, patients with BPD and OPD reported more phobic symptoms, greater interpersonal sensitivity, and more paranoid ideation. Uniquely, BPD patients were more angry than OPD patients. BPD patients had high novelty seeking, high harm avoidance, low self-directedness, and low cooperativeness. Depressed patients with BPD did poorly in the short term if treated with nortriptyline rather than fluoxetine. After 6 months, those with BPD had a favorable outcome in regard to depressive symptoms, social adjustment, and even improvement in the character measure of self-directedness. Those with the poorest outcome were those with OPD.
Joyce
Peter R
PR
Department of Psychological Medicine, Christchurch School of Medicine, Christchurch, New Zealand.
Mulder
Roger T
RT
Luty
Suzanne E
SE
McKenzie
Janice M
JM
Sullivan
Patrick F
PF
Cloninger
Robert C
RC
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D001883:Borderline Personality Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D002605:Character; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D010259:Paranoid Disorders / Q000453:epidemiology; D010698:Phobic Disorders / Q000453:epidemiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012917:Social Adjustment; D013696:Temperature; D016896:Treatment Outcome
D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors