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Effectiveness of Electroconvulsive Therapy in Patients With Major Depressive Disorder and Comorbid Borderline Personality Disorder

Lee, James H.*; Kung, Simon, MD; Rasmussen, Keith G., MD; Palmer, Brian A., MD, MPH

doi: 10.1097/YCT.0000000000000533
Original Studies

Objective Previous research suggests that electroconvulsive therapy (ECT)—the criterion standard for the treatment of severe depression—is not as effective when the patient has comorbid borderline personality disorder (BPD). The ECT outcomes of patients with and without BPD were compared in a retrospective chart review to test this claim.

Methods We enrolled 137 patients with a diagnosis of major depressive disorder who completed the McLean Screening Instrument for Borderline Personality Disorder. Twenty-nine patients had positive screening scores for BPD. The difference in Patient Health Questionnaire (PHQ-9) scores before and after ECT was compared between patients with and without BPD. Follow-up PHQ-9 scores determined after treatment were collected and analyzed.

Results Electroconvulsive therapy equally improved symptoms of depression as measured by PHQ-9 score in both patients who screened positive and patients who screened negative for BPD. No difference in the increase in PHQ-9 scores between these 2 groups was noted 1 month after treatment (P = 0.19).

Conclusions These data showed that a positive BPD screen does not necessarily predict a poorer response to ECT, nor does it predict greater symptom recurrence after ECT. This does not suggest that ECT is necessarily an appropriate treatment for major depressive disorder in patients with a comorbid BPD, given the limitations of screening instruments.

From the *Mayo Clinic School of Medicine, Mayo Clinic College of Medicine and Science; and

Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.

Received for publication June 18, 2018; accepted June 19, 2018.

Reprints: Brian A. Palmer, MD, MPH, Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail:

This publication was supported by CTSA grant UL1 TR002377 from the National Center for Advancing Translational Science. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The authors have no conflicts of interest or financial disclosures to report.

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