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The depressed borderline: one disorder or two?

P H Soloff1, J Cornelius, A George

  • 1Department of Psychiatry, University of Pittsburgh, Western Psychiatric Institute and Clinic, PA 15213.

Psychopharmacology Bulletin
|January 1, 1991
PubMed
Summary
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Depression in borderline personality disorder (BPD) is complex and often chronic. While medications offer modest symptom relief, a combination of pharmacotherapy and psychotherapy is essential for comprehensive treatment.

Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Pharmacology

Background:

  • Depression in borderline personality disorder (BPD) presents heterogeneously, often chronically.
  • It can manifest as reactive mood, character expression, or comorbid affective disorder.

Purpose of the Study:

  • To review the literature on depression in BPD.
  • To examine pharmacologic treatments and their efficacy.
  • To explore the underlying etiologies of BPD.

Main Methods:

  • Literature review encompassing comorbidity, longitudinal studies, family history, laboratory findings, and pharmacotherapy.
  • Analysis of medication effects on depressed mood in BPD, independent of comorbidities.

Main Results:

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  • Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) yield modest symptom improvement, not consistently for depression.
  • Medication efficacy is independent of comorbid diagnoses like major depression or atypical depression.
  • Residual symptoms are common post-treatment.

Conclusions:

  • Borderline patients exhibit core biologic affective dysregulation and pathologic personality organization.
  • Etiologies are both constitutional and psychodynamic.
  • Comprehensive treatment requires integrating pharmacotherapy and psychotherapy.