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:
•persistently depressed or irritable mood
•diminished interest or pleasure in activities
•significant decrease or increase in appetite, or weight loss or weight gain
•increased or decreased sleep
•decreased mental and physical activity, or increase in such activity as demonstrated by excessive worrying and agitated behavior
•fatigue, or loss of energy
•feelings of worthlessness or excessive or inappropriate guilt
•diminished ability to think or concentrate, or indecisiveness
•recurrent thoughts of death and dying, recurrent suicidal thoughts with a specific plan, or a suicide attempt

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:
•sad, depressed, and lonely feelings are frequently triggered by some life event and are often associated with strong feelings of emptiness, loneliness and fears of abandonment.
•symptoms readily improve if the situation causing them improves
•sleep, appetite and energy disturbances (if present) are usually related to an identifiable life stress and stop when the stress is managed successfully.
•acute suicidal thoughts and self-injurious behavior are usually the direct result of a personal problem (for example, an argument with a parent, boyfriend, spouse, or boss)

Bipolar II Disorder-Depressed*

In bipolar disorder-depressed, the symptoms of a major depressive episode listed above are often characterized by:
•increased appetite or weight gain
•increased sleep and napping
•marked decrease in mental and physical activity
•marked fatigue and loss of energy

Major Depressive Disorder

In major depressive disorder, the symptoms of a major depressive episode listed above are often characterized by:
•decreased appetite or weight loss
•decreased sleep with early morning awakening
•increased mental and physical activity as demonstrated by excessive worrying and agitated behavior

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
•Bupropion (Wellbutrin&orig;)* drug of choice
•Lamotrigine (Lamictal&orig;)
•SSRIs such as fluoxetine (Prozac&orig;) or sertraline (Zoloft&orig;) if bupropion and lamotrigine are ineffective

Treatment for Depression in Major Depressive Disorder without Atypical Features
•SSRIs such as fluoxetine or sertraline* drug of choice
•Bupropion and lamotrigine if SSRIs are ineffective

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).