Personality disorders are common in patients with active Axis I disorders but research has shown that their presence may be confounded by the clinical state of the patient.

To investigate further, Dr Maurizio Fava and colleagues at Harvard Medical School in Boston assessed both personality disorders and personality traits in patients before and after treatment with antidepressants.

They enrolled 384 outpatients with major depressive disorder to take part in an eight-week trial of open treatment with fluoxetine. Psychiatric measures (SCID-P, SCID-II and HAM-D-17) were assessed at baseline and at the end of the treatment period.

Nearly two-thirds of patients met the diagnostic criteria for at least one co-morbid personality disorder at baseline, most commonly, obsessive-compulsive and avoidant in nature. However, a significant proportion of these patients no longer met criteria for personality disorder following antidepressant treatment.

Changes in personality disorder traits were significantly related to degree of improvement in depressive symptoms in some, but not all, personality disorders.

Dr Fava and colleagues said that the relative lack of stability of personality disorder diagnoses among patients with current major depression might be due, not only to changes in a depressive state, but also to the “possible treatment effects of antidepressants on behaviors and attitudes that comprise personality disorders”.

Reference: Fava et al, Psychological Medicine 2002;32:1049-1058

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