Treatment Outcomes of Electroconvulsive Therapy for Depressed Patients With and Without Borderline Personality Disorder: A Retrospective Cohort Study

Abstract

Background: Electroconvulsive therapy (ECT) is the gold-standard treatment for refractory depression. Borderline personality disorder (BPD) is generally considered a poor predictor of treatment response. We sought to assess symptom-severity outcomes among depressed patients, with and without BPD, undergoing acute phase ECT.

Methods: The study sample consisted of at least moderately depressed patients who received an acute course of ECT from January 2011 to December 2016 at a freestanding psychiatric hospital. Participants completed a DSM-IV-validated BPD screening instrument (MSI-BPD) at baseline. Measures of DSM-IV depressive symptom severity (QIDS-SR) were taken serially on four occasions. Outcomes of interest comprised total QIDS-SR score trajectory, as well as QIDS-SR suicidality subscore and symptom clusters posited to differentiate response among antidepressant treatments.

Results: 693 individuals met study inclusion criteria, 145 (20.9%) of whom screened positive for BPD. Overall, ECT was associated with significant improvement of depressive symptoms (χ2(1) = 504.8, p < 0.0001). Despite differing from BPD(-) individuals on key baseline features, BPD(+) individuals responded to ECT with similar improvement in overall depression severity (χ2(1) = 0.22, p = 0.64), suicidality (χ2(1) = 1.63, p = 0.20), and core emotional (χ2(1) = 0.63, p = 0.43), sleep (χ2(1) = 0.20, p = 0.65), and atypical (χ2(1) = 1.30, p = 0.25) symptoms after 15 treatments. Post hoc analysis indicates a slightly less robust overall response among BPD(+) by the 15th treatment.

Conclusion: Acute course ECT benefits depressed patients, with or without co-morbid BPD, although patients with BPD may exhibit less pronounced improvement over time.

Key words: electroconvulsive therapy, borderline personality disorder, depression