Role of Electroconvulsive Therapy in Major Depressive Disorder with Borderline Personality Disorder: Case Report and Literature Review

Abstract

Major depressive disorder (MDD) becomes difficult to treat when the patient has a comorbid personality disorder. For such patients, even a combination of psychotherapy and pharmacotherapy has been ineffective. Electroconvulsive therapy (ECT) has been the first line of therapy for the treatment-resistant depression. We used this mode of therapy for a patient who had MDD along with borderline personality disorder and had failed trials of multiple medications and psychotherapy. ECT was very successful in our patient.

Can electrical interventions be helpful in treating mood disorders in patients diagnosed with personality disorders? Case report and literature review.

“…Similar to the patient described in this case report, Wasiq et al obtained a significant improvement in the clinical condition of a patient, suffering from depressive disorders and BPD, who had been unsuccessfully treated with pharmacotherapy and psychotherapy for 10 years, indicating the need for further research in this area [7].…”

“…Współchorobowość w przebiegu zaburzeń depresyjnych jest duża; szacuje się, że w 40% towarzyszą im zaburzenia osobowości, a w 20% zespół uzależnienia od alkoholu [6]. Kolejne badania wskazują na współchorobowość sięgającą od 30 do 80% [7].…”

“…Podobnie jak w przypadku opisanej w tym artykule pacjentki, Wasiq wsp. uzyskali istotną poprawę stanu klinicznego pacjenta, chorującego na zaburzenia depresyjne i BPD, który od 10 lat był bezskutecznie leczony za pomocą farmakoterapii i psychoterapii, wskazując na potrzebę dalszych badań w tym zakresie [7].…”

“…Comorbidity in the course of depressive disorders is high; it is estimated that 40% are accompanied by personality disorders and 20% by alcohol dependence syndrome [6]. Subsequent studies indicate co-morbidity ranging from 30 to 80% [7].…”

Ketamine as an Alternative Anesthetic for Augmenting Seizure Durations During Electroconvulsive Therapy

“…8 Ketamine, an N-methyl-D-aspartic acid receptor antagonist, may provide additional benefits for ECT in patients with major depression owing to its independent antidepressant effect. [9][10][11] Although the efficacy of ketamine as a first-line anesthetic for ECT has been inconsistent and controversial in randomized controlled trials (RCTs), [12][13][14][15] a meta-analysis has shown that ketamine induces a longer seizure duration than other anesthetics, including propofol, thiopental, and methohexital. 16 Therefore, ketamine may improve the quality of seizures that maybe short or difficult to induce using other anesthetics.…”