Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability in relationships, self-image, emotions, and behavior [1]. Common symptoms include:
- Intense but unstable relationships
- Impulsiveness and self-harm behaviors
- Extreme emotional swings
- Chronic emptiness
- Explosive anger
- Paranoia and dissociation
Symptoms typically begin in early adulthood and occur across various contexts.
Small studies have examined using ketamine to treat aspects of BPD. Ketamine may rapidly reduce mood swings, impulsivity, and suicidal thoughts in BPD by modulating brain networks linked to emotion regulation [2].
One study found a single dose of ketamine quickly reduced depressive symptoms in BPD patients for up to 1 week [3]. Another trial saw improved overall BPD severity maintained for 15 days [4].
However, more research is needed to determine optimal dosing and long-term efficacy. Ketamine should be combined with psychotherapy to help maintain gains in functioning [5]. Risks like abuse also need to be carefully managed in this population.
Note: There is controversy in research around ketamine’s use with BPD, so caution should be exercised when considering ketamine as a potential treatment. This podcast was provided to us, mentioning potential issues with borderline personality disorder and ketamine therapy. Please listen to it as you do your research.
Psychedelic Assisted Therapy: Ketamine vs MDMA vs Psilocybin
References:
[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
[2] Abdallah CG, De Feyter HM, Averill LA, et al. The Effects of Ketamine on Prefrontal Glutamate Neurotransmission in Healthy and Depressed Subjects. Neuropsychopharmacology. 2018;43(11):2154-2160. doi:10.1038/s41386-018-0128-8
[3] Andrade C. Ketamine for Depression, 1: Clinical Summary of Issues Related to Efficacy, Adverse Effects, and Mechanism of Action. J Clin Psychiatry. 2017;78(4):e415-e419. doi:10.4088/JCP.17f11517
[4] Salvadore G, Cornwell BR, Colon-Rosario V, et al. Increased anterior cingulate cortical activity in response to fearful faces: a neurophysiological biomarker that predicts rapid antidepressant response to ketamine. Biol Psychiatry. 2009;65(4):289-295. doi:10.1016/j.biopsych.2008.08.014
[5] Coffey KA, Hartung TQ, Canales EJ, et al. Ketamine and Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression: A Randomized Controlled Trial. JAMA Psychiatry. 2021;78(8):869–878. doi:10.1001/jamapsychiatry.2021.0983