Ketamine/esketamine in the treatment of depression with comorbid borderline personality disorder or traits: A systematic review of effectiveness
Australian & New Zealand Journal of Psychiatry – September 20, 2025
Source: OpenAlex
Summary
Ketamine and esketamine show promise in alleviating depression symptoms for individuals with borderline personality disorder, potentially benefiting a population often grappling with severe mental health challenges. However, caution is warranted due to reports of suicidal ideation and self-harm post-treatment cessation. Limited data from existing studies highlight the risk of acute dissociation in these patients. While current findings are encouraging, a larger randomized controlled trial is essential to better understand efficacy and side effects before widespread clinical application.
Abstract
This is the first systematic review to assess the effectiveness of ketamine/esketamine in this cohort. Our findings suggest that ketamine/esketamine may be useful in improving symptoms of depression, in those with comorbid borderline personality disorder. Limited study data are available; however, given case reports of suicidal ideation and self-harm following treatment cessation, as well as indications of a higher risk of acute dissociation in individuals with borderline personality disorder, clinicians should exercise caution when using ketamine to treat depression in this population. More data are required including a larger randomised control trial to assess the efficacy and side effects of ketamine/esketamine in this study population. Clinicians should, where available and appropriate, consider offering ketamine/esketamine to patients in this cohort.