The Relationship of Personality Disorders to Treatment Outcome in Depressed Outpatients
J Clin Psychiatry 2003;64(3):259-264
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Many clinicians believe that
depressed patients with comorbid personality disorder(s) may
respond differently to standard treatments than patients with
depression alone. Personality disorders appear to be common among
patients with depression, suggesting potentially significant
treatment implications for a large group of patients.
Method: Subjects with DSM-III-R major depression
were recruited for a study looking at prediction of
antidepressant response. All patients were assessed using the
Structured Clinical Interviews for DSM-III-R Axis I and Axis II,
as well as rated on the Hamilton Rating Scale for Depression and
the Montgomery-Asberg Depression Rating Scale (MADRS). Patients
were then randomly assigned to treatment with fluoxetine or
nortriptyline and reassessed at 6 weeks. The major outcome
measure was percentage reduction in MADRS scores.
Results: Of the 183 patients who completed the
personality disorder assessment, 45% had at least 1 comorbid
personality disorder. Subjects with comorbid personality
disorders were slightly younger, more depressed at baseline, had
poorer social adjustment, more general psychopathology, and more
chronic depression. Despite these differences, the presence of a
comorbid personality disorder did not adversely affect overall
outcome at 6 weeks, but there was an interaction between having a
comorbid personality disorder and drug type. The major effect was
that patients with a cluster B personality disorder did
relatively poorly on nortriptyline compared with fluoxetine
Conclusion: The finding that the presence of a
comorbid personality disorder does not affect overall treatment
response is similar to that reported by some recent studies. The
finding that patients with cluster B personality disorders
respond poorly to nortriptyline is also consistent with a small
literature on borderline personality disorder.