Résumé
Background: personality disorders (PD) including borderline personality disorders (BPD) respond poorly to psychotropic treatments and can be challenging to treat via psychotherapy. Ketamine and esketamine, currently used in treatment-resistant depression and suicidal ideation (SI), offer promising strategies in PD. Methods: we conducted a systematic review, searching PubMed, PsycInfo, Scopus and Web of Science databases for peer-reviewed articles reporting efficacy on depression, anxiety, SI and tolerability of major side effects of ketamine or esketamine in PD until September 9th 2024. Results: of 394 identified articles, 18 were included, representing 814 patients of whom 249 were diagnosed with PD. Most studies gave 0.5 mg/kg intravenous ketamine over 40 minutes, though some explored flexible dosing, esketamine, oral ketamine from one single session to long-term treatment (up to 15 months). Ketamine has been shown to be as effective in PD with or without major depressive disorder on depression, anxiety and SI. Moreover, promising results for management of long-term BPD symptoms were noted. Tolerability was similar to the non-PD population. Dissociation was possibly beneficial to good outcomes. Discussion: ketamine represents an innovative treatment option for PD. SI relief does not necessarily correlate with mood or anxiety improvement, and people report cognitive changes and increased ability to cope with daily life situations. This review emphasizes the need for standardized protocols and confirmation of long-term efficacy on BPD severity and social functioning. Further research could explore higher doses, multiple session cycles, and ketamine-assisted psychotherapy.