Systematic review and meta-analysis of the role of personality disorder in randomised controlled trials of pharmacological interventions for adults with mood disorders

Impact of Comorbid Personality Disorders on Depression Treatment in Routine Outpatient Care

“…This range was exceeded in our study, which found the average length of psychotherapy to be 22 sessions. Moreover, findings from well-designed studies (16)(17)(18)(19) with controlled treatment have not indicated that comorbid personality disorders negatively affect acute-phase depression outcomes; therefore the need for additional therapy remains questionable. Given the current problems in the timely availability of treatment in Dutch mental health care (40,41), it is important not to unnecessarily extend therapy.…”

“…According to Mulder, this difference in findings could be explained by patients with these comorbid conditions receiving less optimal treatment in uncontrolled studies, because such studies are likely biased by clinicians who regard a personality disorder as a relevant factor in treatment selection. Three meta-analyses have contributed to Mulder's hypothesis, indicating no significant differences in outcomes between individuals with and without personality disorders in controlled trials of pharmacotherapy (16,17) and cognitive-behavioral therapy HIGHLIGHTS Individuals with personality disorders received more sessions of psychotherapy for depression than individuals without these disorders. Personality disorders did not affect the number of pharmacotherapy visits nor crisis visits for depression.…”

“…Because individuals with personality disorders appear to have better treatment outcomes in studies with controlled treatment selection, the less satisfactory outcomes of naturalistic designs may be incorrectly attributed to the comorbid condition, instead of to insufficiently provided depression treatment. On the basis of these metaanalyses (16)(17)(18)(19), one could hypothesize that with care as usual, treatment provision may be less optimal for individuals with personality disorders. However, only a few older studies (20,21) have reported on this issue, indicating that individuals with comorbid personality disorders receive less pharmacotherapy and electroconvulsive therapy (ECT) for depression, compared with counterparts without comorbid personality disorders.…”

Pharmacotherapy of Personality Disorders

“…On the other hand, the combination of SSRIs with different psychological approaches such as dialectical behavior therapy (DBT), interpersonal psychotherapy (IPT), or cognitive-behavioral therapy (CBT) could be a promising treatment strategy. The same year, however, another review and meta-analysis concluded that the presence of PD does not have a negative influence on the efficacy of a pharmacological treatment of a comorbid mood disorder (Kavanagh et al 2021). Furthermore, experts recommend that in case of comorbidity of borderline PD and depression, treatment should take priority on borderline PD as depression appears to remit with remission of borderline PD (Gunderson and Links 2014).…”

The prevalence of personality disorder in mental state disorder

“…An early systematic review suggested that personality disorder doubled the odds of treatment being ineffective [37]. However, a more recent meta-analysis including solely randomised trial data suggested personality disorder had no appreciable impact on depression treatment outcome [38]. Interpretation of evidence is complicated by the fact that personality disorder is a common exclusion criterion in treatment trials despite high rates of co-occurrence.…”