Ketamine Infusions Show Promising Effects on Borderline Personality Disorder Symptoms
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A new study has identified that infusions of ketamine may help to reduce the severity of symptoms associated with borderline personality disorder (BPD). The study also found that people who have both depression and BPD respond to ketamine in the same way as people with depression alone, suggesting that ketamine might be a useful treatment option for people with this challenging combination of psychiatric conditions.
The study, led by Joshua Rosenblat from the Department of Psychiatry at the University of Toronto, was published in Psychiatry Research.
What is BPD?
BPD is a condition that affects a person's relationship with themselves and others. Common symptoms include difficulties in maintaining close personal contacts, partly due to extreme mood swings and reactivity to perceived slights. Impulsivity and suicidal behaviors are also features of BPD. Once regarded as untreatable, psychiatry’s understanding of the condition has advanced, and therapeutic options have become more commonplace.
BPD is often seen in combination with major depressive disorder and up to 28% of patients in psychiatric clinics are thought to meet BPD criteria. Intravenous and intranasal ketamine has recently been recognized as a potential treatment option for major depression. Patients are infused with doses of the drug under close medical supervision in a clinical setting. Researchers have debated for some time whether individuals with co-occurring BPD will see less benefit from ketamine treatments, and whether the sedative and non-classical psychedelic drug will have any beneficial effects on their BPD symptoms.
The current analysis reviewed data from patients treated at the Canadian Rapid Treatment Centre of Excellence (CRTCE), now known as Braxia Health. All 100 participants had a particularly stubborn form of depression known as treatment-resistant depression, and half had co-occurring BPD. All received four infusions of ketamine over two weeks.
The headline finding from the study was that both patients with and without BPD saw similar improvements to their depression symptoms. The groups’ depression was measured using the Quick Inventory of Depressive Symptomatology–Self Report (QIDS), a 16-item diagnostic rating system. The group with BPD, who had a QIDS score of 18.78 when they began the study, had a 5.95-point reduction after four infusions. For the BPD-negative group, the baseline score was 17.70 and the reduction was 3.99 points.
The Borderline Symptom List (BSL) was used to assess the severity of patients’ BPD. The group who had BPD at first measurement saw a reduction of 0.64 points on this four-point scale after four infusions. The authors point out that this reduction is comparable or superior to the benefit produced by dialectical behavioral therapy, a leading form of treatment for BPD.
The authors additionally measured related factors such as how suicidal patients felt, whether they had symptoms of anxiety and how they functioned in daily life. All metrics improved after treatment in patients with and without BPD.
The study authors noted that a previous analysis of ketamine infusion in BPD found no benefit from the drug, albeit in a protocol that only administered a single dose of ketamine. The current study has some limitations – there was no placebo group of individuals who didn’t receive ketamine, and studies designed to specifically measure multiple ketamine doses’ effect on BPD symptoms will need to be planned to fully investigate this effect.
Nevertheless, as the authors note, BPD lacks any FDA-approved medication options. These first hints that ketamine could have a use in treatment for the condition are a green shoot in an otherwise barren therapeutic landscape.
Reference: Danayan K, Chisamore N, Rodrigues NB, et al. Real world effectiveness of repeated ketamine infusions for treatment-resistant depression with comorbid borderline personality disorder. Psychiatry Res. 2023;323:115133. doi: 10.1016/j.psychres.2023.115133