The Diagnosis and Treatment for Depression Co-Occurring with Borderline Disorder

The majority of people with borderline disorder suffer from episodes of major depression. Treatment 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.

Symptoms of a Major Depressive Episode:

Understand the differences in symptoms of Borderline Disorder, Bipolar Disorder-Depressed and Major Depressive Disorder, and learn about the various plans for treatment for depression.

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, or if you have developed a bipolar II disorder- depressed or major depressive disorder.

Depressed Mood in Borderline Disorder

In borderline disorder alone, depressed mood often occurs as follows:

Bipolar II Disorder-Depressed*

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

Major Depressive Disorder

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 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 may have merit:

Treatment for Depression in Bipolar Disorder-Depressed 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 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 disorder appear to be related to depressions referred to as atypical depression and seasonal affective disorder (SAD).

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