A feasibility trial of conjoint magnetic seizure therapy and dialectical behavior therapy for suicidal patients with borderline personality disorder and treatment-resistant depression

Abstract

Non-invasive brain stimulation interventions for treating suicidal ideation in individuals with treatment-resistant depression offer the potential for new therapeutic options for patients with borderline personality disorder (BPD), a condition that responds poorly to antidepressant medications. Here we present a study to explore the application of magnetic seizure therapy (MST) in an open-label pilot trial of moderately to severely suicidal individuals with comorbid BPD and treatment-resistant depression conducted at the Centre for Addiction and Mental Health (Toronto, Canada). Using a non-randomized, case-control design, we investigated the feasibility and initial clinical effects of 5 weeks of conjoint MST and dialectical behaviour therapy (MST + DBT) compared with 5 weeks of DBT alone. Changes in primary symptom outcomes of suicidal ideation on the Modified Scale for Suicide Ideation and clinician-rated depression severity on the Hamilton Rating Scale for Depression – 24 were investigated using multilevel models. Additional outcomes included self-reported depression, BPD symptom severity and cognitive functioning. Out of 62 screened participants, n = 21 were enrolled, and N = 19 completed the intervention (n = 9 MST + DBT and n = 10 DBT only). The intervention was feasible to implement. Conjoint MST + DBT, but not DBT alone, led to a rapid, significant and clinically meaningful reduction in suicidal ideation at 5 weeks that was sustained at four-month follow-up. Conjoint MST + DBT was also associated with significant reductions in clinician-rated depression and BPD interpersonal symptom severity, but neither effect was sustained at four-month follow-up. There were no treatment-related effects on cognition. There were no treatment-related serious adverse events. These findings provide initial evidence to suggest that MST + DBT is a feasible intervention to reduce acute suicide risk in individuals with BPD and warrant further exploration in a sham-controlled randomized clinical trial. Traynor, Ruocco et al. find that the conjoint magnetic seizure therapy and dialectical behaviour therapy lead to a rapid, significant and clinically meaningful reduction in suicidal ideation in individuals with comorbid borderline personality disorder and treatment-resistant depression.