- Article purpose:
- This study looks at how personality disorders (PD) affects how well people recover from depression with treatment. Treatments (therapy, meds) are usually helpful for depression. However, some people don’t get better as expected and one reason for that may be due to personality disorders.
- Personality disorders involve issues in how a person thinks, feels, and behaves. These difficulties can affect how well someone works with their therapist and follows their treatment plan, which are crucial for getting better. Research shows that many people with major depressive disorder (MDD) also have a personality disorder, but it is not clear how this affects their response to treatment.
- This study is part of a larger trial which is testing a drug called minocycline for treatment of MDD. Its goal is to see if having a personality disorder makes it harder for people to improve in their daily living and quality of life (functional outcomes) during depression treatment. The idea is that those with both depression and a personality disorder may have a tougher time than those with just depression. The main focus of the study is to learn if people with personality disorders show less improvement in their day to day function and how personality disorders affect response to MDD treatment. Knowing this will help in making more targeted treatment options for pts with concurrent MDD and personality disorders.
- Methods:
- The study used data from a 12-week trial that investigated the effectiveness of adding 200 mg per day of minocycline to the treatment of major depressive disorder (MDD). The trial followed double-blind, randomized, and placebo-controlled procedures, adhering to Good Clinical Practice guidelines. The participants’ psychotropic medication use, adverse events, and treatment compliance were monitored throughout the trial. PD (personality disorder) was assessed using the Standardized Assessment of Personality – Abbreviated Scale (SAPAS), and clinical impressions, functioning, and quality of life were measured using various scales.
- SAPAS
- Eight-item screening interview for personality disorder [4]. Each item is worded as a question to be answered with yes or no (e.g., item 1: “In general, do you have difficulty making and keeping friends?”). When the response is given that indicates pathology (i.e., yes to item 1), the interviewer must follow up by asking if that is true in general.
- Inclusion criteria:
- Participants were recruited from three sites, and eligibility criteria included meeting DSM-IV criteria for MDD:
- 5 or more depressive symptoms for ≥ 2 weeks
- Depressed Mood
- Markedly diminished interest or pleasure in most or all activities
- Significant weight loss (or poor appetite) or weight gain
- Insomnia or hypersomnia
- Psychomotor retardation
- 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 (not just fear of dying), or suicidal ideation, plan, or attempt
- Must have either depressed mood or loss of interest/pleasure
- Symptoms must cause significant distress or impairment
- No manic or hypomanic behavior
- 5 or more depressive symptoms for ≥ 2 weeks
- Having a baseline score of ≥ 25 on the Montgomery Asberg Depression Rating Scale (MADRS),
- The MADRS consists of ten items that assess various aspects of depression, including mood, feelings of unease, sleep disturbances, appetite changes, concentration, and energy levels. Each item is scored on a scale from 0 to 6, with higher scores indicating more severe symptoms. The total score ranges from 0 to 60, with higher scores indicating more severe depression
- Stable antidepressant treatment for at least 2 weeks prior to randomization.
- The study involved 71 participants who completed the trial. PD was determined using the SAPAS at week 4.
- Participants were recruited from three sites, and eligibility criteria included meeting DSM-IV criteria for MDD:
- Results:
- After adjusting for age, sex, and baseline outcomes, no significant differences were observed in week 12 scores for various outcome measures. The presence of Panic Disorder did not show significant associations with treatment response or functional outcomes as measured by the specified rating scales in this study.
- Key findings:
- The study found that 69% of the participants met criteria for having a personality disorder (PD). Majority of the pts in this study have a cluster C personality disorder (obsessive-compulsive personality disorder, dependent personality disorder and avoidant personality disorder). People with PD were more likely to report other mental health issues and a history of persistent depressive symptoms. The study looked at whether the presence of PD affected how well people responded to treatment for depression. They found that there were no significant differences between those with and without PD in terms of improvement or remission from depression symptoms after 12 weeks of treatment.
- Limitations:
- The study acknowledges some limitations, such as using a screening tool instead of a structured clinical interview for PD assessment and not differentiating between specific PDs. Additionally, the researchers note the importance of investigating the efficacy of minocycline for treatment of depression.
- Source:
- Kavanagh BE, Williams LJ, Berk M, et al. Personality disorder and functioning in major depressive disorder: a nested study within a randomized controlled trial. Brazilian Journal of Psychiatry. 2020;42(1):14-21. doi:https://doi.org/10.1590/1516-4446-2018-0308
