SSRIs and Other Antidepressants in Borderline Personality Disorder: Treating Comorbid Depression

Abstract

Antidepressants do not treat affective instability in BPD, and regularly cause emotional blunting that patients find intolerable. Avoid targeting core BPD symptoms with them. Consider using antidepressants for BPD only when comorbid depression significantly impairs functioning; the indication is the comorbid condition. SSRIs outperform DBT for reducing comorbid MDD at 6 months in BPD (Brodsky et al. 2025). Add an SSRI when major depression is the primary clinical target.