The Diagnosis and Treatment of Depression Co-Occurring with Borderline Personality Disorder

The majority of people with borderline disorder suffer from episodes of a major depression. The typical treatments for depression is vital in these individuals. There are two categories of major depressive episodes, those associated with bipolar I and II disorder-depressed*, and those referred to as major depressive disorder*. Bipolar depressions are more frequent with borderline disorder, and are commonly associated with atypical features (see below).

Therefore, if you have borderline disorder, it is important that you know and recognize the symptoms of these disorders. If they occur, you should alert your physician so that you may receive prompt treatment for depression.

Depression in Borderline Personality Disorder is Different Than in Bipolar  and Major Depressive Disorders, and Requires Different Treatment

In order to initiate the proper treatment for depression, it is necessary to determine if you are experiencing a decrease in mood associated with borderline disorder, which I refer to as a borderline depression, or if you have developed a bipolar II disorder-depression or major depressive disorder.

Depressed Mood in Borderline Disorder

In borderline disorder alone, the typical symptoms of a borderline depression occur are:

Treatment of  Depressed Mood In Borderline Disorder

Once your depressed mood and other symptoms are identified as a borderline depression, your psychiatrist will be able to select the most appropriate treatments for you. It will usually include increased frequency of psychotherapy sessions, a change in the dose of one of your current medications or the temporary addition of a new class of medication. it is common that the frequency and severity of these episodes of depressed mood will decline as your treatment progresses.

In the meantime, it is important to distinguish borderline depressions from the other two classes of depressions noted above. The symptoms of and the treatments for these depressions follow.

Symptoms of a Major Depressive Episode:

Bipolar II Disorder-Depression*

In bipolar disorder-depressed, the symptoms of a major depressive episode listed above are often characterized by:

Distinguishing a Borderline Depression From A Major Depressive Disorder With or Without Atypical Features and a Bipolar II Disorder-Depression

In major depressive disorder, the symptoms of a major depressive episode listed above are often characterized by:

Atypical Features

The essential characteristics of atypical features are the capacity to be cheered up when experiencing positive events and two of the following: increased appetite and weight gain, nighttime sleep and napping of at least ten hours duration, or two hours more than usual, feeling heavy, leaden, or weighted down, usually in the arms and legs, and moderate to severe sensitivity to rejection.

Treatment for a Major Depressive Disorder Or A Bipolar II Depression  Co-occurring with Borderline Disorder

If you think you have the symptoms of either type of depression, immediately alert your psychiatrist. If appropriate, the treatment for depression frequently involves the addition of an antidepressant, an increase in dosage if one is already being used, and/or the use of behavioral techniques.

There are no controlled studies on the relative effectiveness of different antidepressants for the treatment for depression in people with borderline disorder. However, studies of these disorders in people without borderline disorder, and experience, suggest that the following initial treatment strategies  are often successful:

Treatment for Depression in Bipolar II -Depression and Major Depression with Atypical Features

Treatment for Depression in Major Depressive Disorder without Atypical Features

Note: It is important in the treatment for depression to recognize that some antidepressants, such as tricyclics, may cause an episode of mania or hypomania in patients with depression who have never experienced such episodes in the past.

Cognitive Behavioral Therapy focused on treatment for depression may also prove useful to help identify thought patterns and behaviors that operate as risk factors for mood disorders, and to encourage new, more successful behaviors.

* Bipolar I and II, and major depressive disorders occur more commonly in patients with borderline disorder than they do in the general population. Bipolar II disorder is the most common type of bipolar disorder that occurs with borderline disorder. People with bipolar II disorder do not experience manic episodes as do those with bipolar I disorder, but do experience brief hypomanic periods and recurring episodes of depression. Depressions associated with bipolar II disorder and those with atypical features often occur with depressions with seasonal cycles referred to as seasonal affective disorder (SAD).