Ketamine/esketamine in the treatment of depression with comorbid borderline personality disorder or traits: A systematic review of effectiveness

A systematic review found that ketamine or esketamine may improve depression symptoms in people who also have borderline personality disorder. However, the available data are limited. Case reports describe suicidal ideation and self-harm after stopping treatment, and individuals with borderline personality disorder may face a higher risk of acute dissociation. Clinicians should therefore exercise caution when using ketamine for depression in this population. Larger randomized controlled trials are needed to better assess efficacy and side effects.

Study at a glance

Abstract

This is the first systematic review to assess the effectiveness of ketamine/esketamine in this cohort. Our findings suggest that ketamine/esketamine may be useful in improving symptoms of depression, in those with comorbid borderline personality disorder. Limited study data are available; however, given case reports of suicidal ideation and self-harm following treatment cessation, as well as indications of a higher risk of acute dissociation in individuals with borderline personality disorder, clinicians should exercise caution when using ketamine to treat depression in this population. More data are required including a larger randomised control trial to assess the efficacy and side effects of ketamine/esketamine in this study population. Clinicians should, where available and appropriate, consider offering ketamine/esketamine to patients in this cohort.