Intranasal Esketamine for Treating Inpatients with Borderline Personality Disorder and Comorbid Treatment-Resistant Depression – a Retrospective Chart Review Study

Background: Borderline Personality Disorder (BPD) affects 1.35% of the population and is frequently comorbid with Major Depressive Disorder (MDD), which is frequently treatment-resistant (TRD). Patients with comorbid illness have worse treatment outcomes and functional impairment. Esketamine could ameliorate symptoms of both illnesses. Methods: We conducted a retrospective chart review of inpatients with BPD and MDD admitted to a state psychiatric hospital in a rural NH state who received intranasal esketamine. Results: 10 patients were admitted and received esketamine. Seven patients reported an increase in positive mood states (p = 1), and seven patients denied suicidal ideations after starting treatment (p = 0.22). We also noticed a statistically non-significant increase in impulsive behavior following the start of esketamine treatment (p = 0.611). The duration of these behaviors was shorter compared to patients’ pre-esketamine behaviors (p = 0.612). Conclusion: Further studies are needed to evaluate the efficacy of esketamine in treating patients with BPD and comorbid TRD.