Electroconvulsive therapy for depression with comorbid borderline personality disorder or post-traumatic stress disorder: A matched retrospective cohort study

摘要

Abstract Background The impact of comorbid borderline personality disorder (BPD) or post-traumatic stress disorder (PTSD) on clinical and cognitive outcomes of electroconvulsive therapy (ECT) in patients with major depressive episodes (MDE) is unknown. Objective Compare clinical response and adverse cognitive effects for MDE patients with comorbid BPD or PTSD to MDE only. Methods In a matched retrospective cohort study of 75 patients treated with ECT at an academic psychiatric hospital with DSM-IV MDE and either comorbid BPD, PTSD or both (MDE?+?BPD/PTSD), 75 MDE patients without BPD or PTSD (MDE-only) were matched. We reviewed clinical records to determine treatment response by estimating clinical global impression of improvement (c-CGI) and presence of adverse cognitive effects based on subjective distress or objective impairment. We explored factors associated with response and cognitive effects in the MDE?+?BPD/PTSD group. Results There was no difference in c-CGI response rates between groups (p?>?0.017). Secondary analysis of inpatients found lower response rates for MDE?+?BPD (55.4%) and MDE?+?BPD?+?PTSD (55.8%) than MDE-only (82.5%), but not MDE?+?PTSD (65.0%). There was no difference in adverse cognitive effects in the MDE?+?BPD/PTSD (23.3%–26.8%) group compared to MDE-only (25.0%). In the MDE?+?BPD/PTSD group, factors associated with higher response rate were: referral indications other than failed pharmacotherapy, greater number of ECT treatments, presence of adverse cognitive effects, and seizure duration >30?s. Conclusions Despite a lower c-CGI response for inpatients with MDE?+?BPD, ECT is a viable treatment option for patients in the MDE?+?BPD/PTSD group with similar adverse cognitive effect profiles to MDE-only. Highlights ? Depression with BPD or BPD and PTSD was associated with lower c-CGI response rates than depression only. ? Adverse cognitive effects did not differ between depression only or depression with BPD, PTSD or the combination. ? Several characteristics were associated with c-CGI response or adverse cognitive effects for depression with BPD or PTSD.