Selegiline Eases Comorbid Bipolar I Depression and BPD

NEW YORK CITY—The antidepressant patch selegiline reduced anxiety, depression, and somatic complaints in responders with bipolar I depression and borderline personality disorder in a small trial.

Results were presented at a May 8 poster session at the American Psychiatric Association’s annual meeting by researcher Paul Jay Markovitz, MD, PhD, a general psychiatrist in Santa Barbara, California.

The double-blind, placebo-controlled trial included a total 36 patients, 6 of whom dropped out early. In a 2:1 ratio, patients were randomized to treatment with 12 mg transdermal selegiline daily or placebo over 6 weeks.

The top third of patients in the trial demonstrated a decrease in Hopkins Symptom Checklist-90-Revised scores of 135.1 + 65.7 points with selegiline compared with a reduction of 28.9 + 46.8 points for the entire placebo group, Dr. Markovitz reported.

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Improvements in the treatment group as a whole narrowly missed statistical significance over the placebo group. Dr. Markovitz attributed that to the dropouts in the study, which made the ratio between the active and placebo groups 3:1  for results calculations.

“It wasn’t because it didn’t work,” he said. “The top third of the group did spectacularly and even the whole group did spectacularly.”

Scores on the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Young Mania Rating Scale, and Sheehan Disability Scale showed similar effects. No mania was induced during the trial.

“This small study suggests some depressed patients with comorbid bipolar I and borderline personality disorder respond to transdermal selegiline,” Dr. Markovitz reported. “It also suggests the comorbid symptoms seen in both diseases may have a matching neurochemistry and opens the possibility of antidepressants being true mood stabilizers treating depression, mixed states, and mania in some patients.”

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Further studies, he reported, are needed to validate the findings.

The trial was somewhat of an accident, Dr. Markovitz said. BPD was the only requirement to participate in the research, but all of the patients also turned out to have bipolar I depression.

Dr. Markovitz uses selegiline in some of his patients, but said it is not a first-line medication because of the cost, about $1700 a month without insurance.

"But, if I had this disease or some of its conjoint parts, I would unequivocally want to be on this," he said.

Selegiline does not cause sexual dysfunction or require any dietary restrictions, but interaction with stimulants, cocaine, or methamphetamine is fatal, Dr. Markovitz said.

—Jolynn Tumolo and Terri Airov

Reference

“A double-blind placebo-controlled trial of transdermal selegiline in depressed bipolar I patients with borderline personality disorder.” Abstract presented at: the American Psychiatric Association Annual Meeting; May 8, 2018; New York, NY.