Objective: Personality disorders occur in 10-30% of patients with late life major depression. In younger patients they are associated with treatment resistance, but there is little information on the treatment of depression in older adults with comorbid personality disorders. This preliminary study evaluates the clinical correlates and response rate to antidepressant treatment of elderly patients with a major depressive disorder and at least one comorbid personality disorder.
Design: Older adult patients with depression and at least one personality disorder were recruited for an eight-week naturalistic clinical treatment study using standard SSRI medications.
Materials and Methods: Patients were assessed at baseline by clinical and SCID interviews for the presence of depression and comorbid personality disorders. The Hamilton Depression Scale (HAM-D) was conducted at baseline and after 8 weeks of treatment. Improvement was evaluated by testing the difference between the HAM-D scores at baseline and week 8 using a paired-samples t-test. All patients were treated using a standard SSRI (fluoxetine, sertraline, paroxetine) at therapeutic doses.
Results: Thirty-four older adults (mean age 61) were enrolled in the study. The mean HAM-D at intake was 21. The average number of Axis II diagnoses for each patient was 1.9 (range 1-4). Most common Axis II diagnoses were Obsessive Compulsive Personality Disorder (82%), Avoidant Personality Disorder (35%), Borderline Personality Disorder (27%), and Paranoid Personality Disorder (24%). At week 8 the mean HAM-D score was 15 (p<0.001, t=6.2). Though improved, most patients (91%) still reported significant subjective symptoms of depression and met criteria for at least a mild depression. Only 3 patients achieved remission (HAM-D<7).
Conclusion: The presence of a comorbid personality disorder in elderly patients is associated with a poorer response to standard antidepressant treatment. Results are consistent with studies in younger depressed patients with comorbid personality disorders.
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