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Depression in Patients with Borderline Personality Disorder

Yoshimatsu, Kei MD; Palmer, Brian MD, MPH

doi: 10.1097/HRP.0000000000000045

Borderline personality disorder (BPD) and major depressive disorder (MDD) commonly co-occur, but the relationship between these disorders remains unclear. While BPD patients often suffer from depression, their subjective experience and treatment response are different from that experienced by MDD patients without BPD. Surveying the current literature on the interface of these two pathologies, we find that depression in BPD has distinct symptoms, treatment responses, remission predictors, and suicide risks. It tends to be subjectively more severe, more interpersonally fueled, and more persistent than MDD without BPD. BPD depression responds less well to biological treatments and may be fueled by the neurobiology of BPD. These findings suggest that clinicians should recognize the unique features of BPD depression and anticipate a clinical trajectory that may be different from MDD without BPD, keeping in mind that BPD depression tends not to improve until BPD improves.

From Mayo Medical School (Dr. Yoshimatsu) and Department of Psychology and Psychiatry, Mayo Clinic (Dr. Palmer).

Original manuscript received 20 October 2013; revised manuscript received 14 April 2014, accepted for publication 20 May 2014.

Correspondence: Brian Palmer, MD, MPH, 200 First St. SW, Rochester, MN 55905. Email: Or: Kei Yoshimatsu, MD, 401 Parnassus Ave., San Francisco, CA 94143. Email:

© 2014 President and Fellows of Harvard College
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