The importance of Axis II in patients with major depression. A controlled study

Using a naturalistic study design, we compared 76 depressed patients having a DSM-III personality disorder (PD) to a control group of 152 depressed patients with no personality disorder. The patients with major depressive disorder (MDD) and a PD were more likely to have had a younger age of onset, to have had prior hospitalizations, to have a longer duration of episode, to have reported more suicidal thoughts, and to have had more suicide attempts both before and after discharge. Patients with MDD and PD were also more likely to have a family history of alcoholism or antisocial personality and less likely to have dexamethasone nonsuppression, although the latter was not statistically significant. Patients with MDD and PD were less likely to receive electroconvulsive therapy (ECT), equally likely to have received antidepressants, and more likely to receive neither ECT nor antidepressants. Patients with MDD and PD had a poorer response to 'adequate' antidepressants, but a similar response to ECT and 'inadequate' antidepressants. Overall, 91 (60%) of MDD patients and 32 (42%) of MDD plus PD patients were recovered at hospital discharge (X2 = 6.43, P less than 0.025). We conclude that the presence of PD in patients with MDD is associated with a different clinical presentation, family history, and poor recovery at hospital discharge.