Combined therapy of major depression with concomitant borderline personality disorder: comparison of interpersonal and cognitive psychotherapy.
OBJECTIVE
The combination of antidepressants and brief psychotherapies has been proven more efficacious in treating major depression and is particularly recommended in patients with concomitant personality disorders. We compare the effects of 2 combined therapies, fluoxetine and interpersonal therapy (IPT) or fluoxetine and cognitive therapy (CT), on major depression in patients with borderline personality disorder (BPD).


METHODS
Thirty-five consecutive outpatients with a diagnosis of BPD and a major depressive episode (not bipolar and not psychotic) were enrolled. They were randomly assigned to 1 of the 2 combined treatments and treated for 24 weeks. Assessment included a semistructured interview, Clinical Global Impression (CGI) scale, Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Beck Depression Inventory-II (BDI-II), Social and Occupational Functioning Assessment Scale (SOFAS), Satisfaction Profile (SAT-P) for quality of life (QOL), and Inventory of Interpersonal Problems (IIP-64). Statistical analysis was performed using the univariate General Linear Model to calculate the effects of duration and type of treatment.


RESULTS
No significant differences between treatments were found at CGI, HDRS, BDI-II, and SOFAS score. Combined treatment with CT had greater effects on HARS score and on psychological functioning factor of SAT-P. Combined treatment with IPT was more effective on social functioning factor of SAT-P and on domains domineering or controlling and intrusive or needy of IIP-64.


CONCLUSIONS
Both combined therapies are efficacious in treating major depression in patients with BPD. Differences between CT and IPT concern specific features of subjective QOL and interpersonal problems. These findings lack reliable comparisons and need to be replicated.
Bellino
Silvio
S
Department of Neurosciences, University of Turin, Torino, Italy. silvio.bellino@unito.it
Zizza
Monica
M
Rinaldi
Camilla
C
Bogetto
Filippo
F
D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D001883:Borderline Personality Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005473:Fluoxetine / Q000627:therapeutic use; D006801:Humans; D007398:Interpersonal Relations; D010549:Personal Satisfaction; D011788:Quality of Life / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index
D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors