Borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) share overlapping neurobiological mechanisms, particularly reward deficiency and stress-like anti-reward processes. The authors propose reclassifying BPD as a "traumatic personality stress disorder" (TPSD) to unify therapeutic strategies that may stabilize dopaminergic reward function, such as psychedelic-assisted therapy (PAT). They argue that PAT could treat trauma-induced personality disorders by addressing these shared mechanisms. Reframing BPD as TPSD may lead to more effective, personalized interventions, reduce stigma, and improve understanding of underlying mechanisms, benefiting conditions characterized by anhedonia, negative affect, hypervigilance, and dissociation.
Since 2000, suicide and opioid overdose rates have risen sharply. About one-third of people with major depressive disorder have treatment-resistant depression, creating an urgent need for new therapies. This narrative review synthesizes key preclinical and clinical findings on low-dose ketamine's rapid antidepressant effects. Low-dose ketamine quickly alleviates depressive symptoms, even in refractory depression. Proposed mechanisms include modulation of dopamine signaling via epigenetic neuroadaptation, interactions with D1/D2 receptor systems, optogenetic activation of D1 pathways, and changes in D2/D3 receptor availability. No consensus exists on its definitive mechanism of action. Ketamine's psychoactive properties and abuse potential underscore the need for enhanced clinical oversight and regulation.