“Esketamine” in Borderline Personality Disorder: A Look Beyond Suicidality
Neethu K Nandan, Puneet K Soni, Ajay K. Parsaik, Aqeel Hashmi
Cureus April 30, 2022 DOI: 10.7759/cureus.24632 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 27-year-old female with borderline personality disorder and treatment-resistant major depressive disorder |
| Interventions | Esketamine Citalopram |
| Dose | 56 mg twice weekly for four weeks, then 56 mg once weekly, titrated to 84 mg once weekly; citalopram 20 mg |
| Duration | Two years |
| Topics | Esketamine |
| Citations | 11 |
| Key findings | The authors report that a patient with borderline personality disorder and treatment-resistant major depressive disorder showed about 70% improvement in depression and anxiety and about 80% improvement in behavioral symptoms after two years of intranasal esketamine plus citalopram. They propose that esketamine may benefit such patients and recommend a trial of intranasal esketamine for BPD with treatment-resistant MDD and frequent self-harm. |
Abstract
Borderline personality disorder (BPD) is an extremely disabling condition that affects almost every dimension of a patient's life. The S-enantiomer of ketamine (esketamine) was approved by the Food and Drug Administration (FDA) in 2019 in conjunction with an oral antidepressant for the management of treatment-resistant depression (TRD) in adults. Our patient is a 27-year-old female with a long-standing diagnosis of BPD and treatment-resistant major depressive disorder (MDD) who presented to a tertiary care hospital after a baleful suicide attempt. As per treatment guidelines, "esketamine" intranasal spray in conjunction with citalopram 20 mg was started in the outpatient setting at a dose of 56 mg twice weekly for four weeks, followed by 56 mg once weekly, which was further titrated to 84 mg once weekly. Two years into treatment, the patient and her mother report around 70% improvement in her depression and anxiety with around 80% improvement in her behavioral symptoms. Esketamine's potential action on patients with BPD can be partially explained by its very well-documented effect on the glutamate receptor antagonism. Additionally, patients with stress-induced suicidal ideations (SI), which are seen in borderline patients, are better responsive to ketamine. In conclusion, we recommend a trial of intranasal esketamine in patients with BPD with treatment-resistant MDD and frequent episodes of self-harm. Treatment with esketamine could potentially reduce the number of emergency room visits for impulsive suicide attempts and help reduce the life burden of BPD and its impact on family members.