Personality Pathology and Treatment Outcome in Major Depression: A Review

Abstract

Whether or not personality pathology significantly worsens outcome in patients with major depression appears to depend on study design, since the rate of personality pathology varies markedly depending on how it is measured. In addition, depressed patients with personality pathology appear less likely to receive adequate treatment in uncontrolled studies. Finally, studies rarely control for depression characteristics (e.g., chronicity, severity) that may influence outcome and be related to personality pathology. Overall, the best-designed studies reported the least effect of personality pathology on depression treatment outcome. Clinically, this suggests that comorbid personality pathology should not be seen as an impediment to good treatment response.

The impact of comorbid depression on recovery from personality disorders and improvements in psychosocial functioning: Results from a randomized controlled trial

“…It has been argued that the relation between personality pathology and treatment outcome in depression might be an artefact of the research design, with the less controlled studies generally supporting such a link whereas controlled studies generally do not support the notion that personality disorders have a negative impact on treatment outcome in depression (Mulder, 2002). The same might hold for the impact of depression on outcome in personality disorders.…”

Pharmacogenetic studies in depression: a proposal for methodologic guidelines

“…It is a very common phenomenon 33 and a recent meta-analysis reported that it has been considered a possible clinical negative predictor of response to treatment, 34 consistently with early studies [35][36][37][38] whereas others reported a similar outcome for people with and without personality disorders comorbidity using only well-designed study 39 consistent with some recent studies. [40][41][42] Apart from specific personality disorders, also temperament traits have been associated with response, generally in the direction of a poorer response in subjects with high harm avoidance. 43,44 The influence of genes on personality is debated as well, though some studies reported the associations of personality disorders with genetic polymorphism, particularly DRD4 and 5-HTTLPR, 45 also in depressed patients 46 these remain still controversial.…”

Two-Year Prospective Naturalistic Study of Remission From Major Depressive Disorder as a Function of Personality Disorder Comorbidity.

“…This design allows for a clear test of whether PDs represent a negative prognostic factor for MDD course (Mulder, 2002). In this study, we examined the 2-year natural course of MDD (remission rate and time to remission) as a function of PD comorbidity.…”