Efficacy of pharmacotherapy in depressed patients with and without personality disorders: a systematic review and meta-analysis

BACKGROUND: During the past decades personality pathology was considered to have a negative influence on the outcome of pharmacotherapy of depressive disorders. Recently, there has been a shift towards a less negative opinion. Still, the evidence in the literature remains inconclusive. This may be explained by methodological differences between published studies.

OBJECTIVE: To present a meta-analysis of the results of Randomised Controlled Trials with pharmacotherapy in the treatment of depression with comorbid personality disorders.

METHOD: Systematic literature search for RCTs in adult ambulatory patients with major depressive disorder and comorbid PDs; pooling of data and meta-analysis according to strict methodological criteria.

RESULTS: The difference in remission rates between the groups with and without personality disorders in high quality studies was 3%; this difference was neither statistically significant nor clinically relevant.

LIMITATIONS: Due to the specific and sensitive methods of the search only six studies could be included in the meta-analysis. Due to lack of data, analyses of drop-out rates could not be made.

CONCLUSION: When only data from high quality RCTs are included, comorbidity of personality disorder and major depression does not have a negative effect on the treatment outcome of pharmacotherapy for major depression.