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EV0836

Self-harm and suicidality during intranasal esketamine treatment for treatment-resistant depression with comorbid borderline personality disorder

SELF-HARM AND SUICIDALITY DURING INTRANASAL ESKETAMINE IN TREATMENT-RESISTANT DEPRESSION WITH COMORBID BORDERLINE PERSONALITY DISORDER

Over six months of follow-up, intranasal esketamine was associated with sustained reductions in self-harm and suicidality, including in the high-risk subgroup with comorbid borderline personality disorder.

The study aimed to examine six-month longitudinal changes during adjunctive intranasal esketamine treatment for treatment-resistant depression (TRD), in which borderline personality disorder (BPD) substantially increases the risk of self-harm and suicide; this high-risk group is generally underrepresented in esketamine studies. In a prospective naturalistic cohort design, 90 outpatients with TRD were followed, of whom 45 had comorbid BPD and 45 had no personality disorder. Assessments were conducted using the DSHI, C-SSRS, and BIS-11 at five time points: baseline, week 2, month 1, month 3, and month 6; Friedman, Wilcoxon, and Spearman tests were used in the analyses. Suicidal ideation and suicidal behavior decreased over time (all p < 0.001), as did the number of types of self-harm and the frequency of self-harm episodes (all p < 0.001); reductions from baseline were evident from month 1 onward. In the BPD subgroup, the mean frequency of self-harm episodes declined from 30.8 at baseline to 2.4 at month 6. Baseline impulsivity was associated with self-harm and, to a lesser extent, with suicidality; these associations weakened during follow-up. No serious adverse events, treatment discontinuations, increases in suicidality, or suicide attempts were observed. The authors note that controlled studies are needed to clarify the durability of these effects and the contributions of concurrent treatments and follow-up.

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