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“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)

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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 Ketamine
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.

Comparable studies

Other case reports and case series on esketamine, most cited first.

Study Year Design Participants
Electroconvulsive Therapy, Ketamine, and Esketamine in a Patient with Major Depressive Disorder and Multiple Comorbidities: A Case Report over 10-year Treatment from Adolescence to Adulthood. A patient with treatment-resistant depression and comorbid generalized anxiety... 2025 Case report n = 1
Oral Administration of the NMDA Receptor Antagonist S-Ketamine as Add-On Therapy of Depression: A Case Series Four depressed patients taking standard antidepressants 2009 Case series n = 4
Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series Veterans with co-morbid depression and PTSD 2022 Retrospective case series n = 35
Case report: Intramuscular ketamine or intranasal esketamine as a treatment in four patients with major depressive disorder and comorbid anorexia nervosa Patients with anorexia nervosa and a comorbid depressive disorder treated at a private... 2023 Case report n = 4
Repeated oral esketamine in patients with treatment resistant depression and comorbid posttraumatic stress disorder Patients with treatment-resistant depression and comorbid PTSD 2023 Case series n = 5

Citations in the library

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Esketamine Ketamine Anxiety Depression