Department of Psychiatry, Brigham & Women's Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
Department of Psychiatry, Harvard Medical School, Boston, MA; Psychiatric Neurotherapeutics Program, McLean Hospital, Belmont, MA.
J Affect Disord. 2021 Feb 15;281:834-838. doi: 10.1016/j.jad.2020.11.054. Epub 2020 Nov 12.
Comorbid personality disorders are common in patients with major depressive disorder (MDD). Individuals with comorbid borderline personality disorder (BPD) may be less responsive to electroconvulsive therapy (ECT), but it remains unclear whether BPD affects responsiveness to transcranial magnetic stimulation (TMS). We sought to investigate the association between BPD and response to TMS. We conducted a retrospective analysis of individuals receiving TMS (n=356) at McLean Hospital. We also included individuals receiving ECT (n=1434) as a control. All individuals completed the McLean Screening Instrument for BPD (MSI-BPD) at baseline. Response to treatment was measured by the Quick Inventory of Depression Symptomatology Self-Report (QIDS-SR). We performed general linear models (GLMs) to assess the effect of BPD on treatment response to TMS and ECT. At baseline, the ECT group had a higher average QIDS-SR score (21.4 vs. 20.3, p<0.05). For both treatment groups, the number of treatments had a significant effect on depression severity. For the TMS group, there was no significant Group x Time interaction on QIDS-SR score (p=0.18). However, for individuals receiving ECT, there was a significant Group x Time interaction on QIDS-SR score (p=0.02), suggesting that BPD significantly impaired response. These results suggest that borderline personality traits did not affect treatment response to TMS for MDD. BPD traits modestly predicted response to ECT, which is consistent with the literature. These results require replication in a clinical trial.
共病人格障碍在患有重性抑郁障碍（MDD）的患者中很常见。共病边缘型人格障碍（BPD）的个体可能对电抽搐治疗（ECT）反应较差，但尚不清楚 BPD 是否会影响经颅磁刺激（TMS）的反应。我们旨在研究 BPD 与 TMS 反应之间的关联。我们对在 McLean 医院接受 TMS（n=356）的个体进行了回顾性分析。我们还包括了作为对照接受 ECT（n=1434）的个体。所有个体在基线时均完成了 McLean 边缘型人格障碍筛查工具（MSI-BPD）。治疗反应通过快速抑郁症状自评量表自我报告（QIDS-SR）来衡量。我们进行了一般线性模型（GLMs）来评估 BPD 对 TMS 和 ECT 治疗反应的影响。在基线时，ECT 组的平均 QIDS-SR 评分较高（21.4 与 20.3，p<0.05）。对于两组治疗，治疗次数对抑郁严重程度有显著影响。对于 TMS 组，QIDS-SR 评分上无显著的组间时间交互作用（p=0.18）。然而，对于接受 ECT 的个体，QIDS-SR 评分上存在显著的组间时间交互作用（p=0.02），这表明 BPD 显著损害了反应。这些结果表明，边缘型人格特质并未影响 TMS 治疗 MDD 的反应。BPD 特质适度预测了 ECT 的反应，这与文献一致。这些结果需要在临床试验中进行复制。
