Eligibility Details:
Inclusion Criteria:
- MST+DBT Group
1. English-speaking and able to provide informed consent to participate in the study
2. Female and between the ages 18 and 50 years
3. Current DSM-IV (Diagnostic and statistical manual of mental disorders-IV)
diagnosis of BPD based on the International Personality Disorder Examination BPD
Section (IPDE-BPD)
4. Current DSM-IV diagnosis of a non-psychotic, major depressive episode, as part of
a broader diagnosis of MDD (single episode or recurrent episode), based on the
Structured Clinical Interview for DSM-IV Axis I Disorders—Patient Edition
(SCID-I/P)
5. Score > 9 (equivalent to moderate-to-severe suicidal ideation) on the Modified
Suicidal ideation Scale for at least the two weeks prior to enrolling in the
study
6. Hamilton Rating Scale for Depression (HRSD-24) score > 22 (classified as Very
Severe Depression)
7. Failed to achieve a clinical response to adequate treatment trials of two or more
antidepressants during the current depressive episode OR have been unable to
tolerate at least two antidepressants as assessed by the Antidepressant Treatment
History Form (ATHF)
8. Deemed appropriate to receive ECT as assessed by an ECT attending psychiatrist
and an anesthesiologist
9. Meets the MST safety criteria
10. Agreeable to keeping their current antidepressant treatment (if any) constant
during the intervention (unless clinically indicated)
11. Has a close family member, friend, partner, or qualified chaperone able and
willing to accompany the patient home after each MST treatment session and
12. Able to adhere to the intervention schedule.
- DBT-Only Group
1. English-speaking and able to provide informed consent to participate in the study
2. Female and between the ages 18 and 50 years
3. Current DSM-IV diagnosis of BPD based on the International Personality Disorder
Examination BPD Section (IPDE-BPD)
4. Current DSM-5 diagnosis of a non-psychotic, major depressive episode, as part of
a broader diagnosis of MDD (single episode or recurrent episode), based on the
Structured Clinical Interview for DSM-IV Axis I Disorders--Patient Edition
(SCID-I)
5. Score > 9 (equivalent to moderate-to-severe suicidal ideation) on the Modified
Suicidal ideation Scale for at least the two weeks prior to enrolling in the
study
6. Baseline Hamilton Rating Scale for Depression (HRSD-24) score > 22
7. Failed to achieve a clinical response to adequate treatment trials of two or more
antidepressants during the current depressive episode OR have been unable to
tolerate at least two antidepressants as assessed by the Antidepressant Treatment
History Form (ATHF)
8. Agreeable to keeping their current antidepressant treatment (if any) constant
during the study (unless clinically indicated)
Exclusion Criteria:
- MST+DBT Group
1. Acute suicidal intent that requires hospitalization to protect harm to self
2. Any unstable medical and/or neurological condition
3. Currently pregnant or lactating, or intention to get pregnant during the duration
of the study
4. Not considered sufficiently physically healthy to undergo general anesthesia for
any reason
5. Any significant neurological disorder or condition likely to be associated with
increased intracranial pressure or cognitive impairment (e.g., a space occupying
brain lesion, a history of stroke, a cerebral aneurysm, a seizure disorder,
Parkinson's disease, Huntington's chorea, multiple sclerosis)
6. Medical condition, medication, or laboratory abnormality that could cause a major
depressive episode or significant cognitive impairment in the opinion of the
investigator (e.g., hypothyroidism with low thyroid-stimulating hormone (TSH),
rheumatoid arthritis requiring high dose prednisone, or Cushing's disease)
7. Current diagnosis of delirium, dementia or another cognitive disorder secondary
to a general medical condition
8. Diagnosis of a developmental disorder (e.g. Down syndrome, autism-spectrum
disorder)
9. Non-correctable clinically significant sensory impairment (i.e., cannot hear or
see well enough to complete the neuropsychological tests)
10. Lower than eighth-grade reading level as assessed by the Wide Range Achievement
Test—Fourth Edition
11. Alcohol or substance use disorder (relating to opioids or cocaine) currently or
within the past 1 month
12. Diagnosis of a DSM-5 psychotic disorder
13. Demonstrated a lack of response to ECT during the current or prior depressive
episode.
14. Requires a benzodiazepine with a dose equivalent to lorazepam 2 mg/day or higher
or any anticonvulsant due to the potential of these medications to limit the
efficacy of both MST and ECT
15. Intracranial implant (e.g., aneurysm clips, shunts, stimulators, cochlear
implants, or electrodes) or any other metal object within or near the head,
excluding the mouth, that cannot be safely removed
16. Has sustained a moderate-to-severe head injury (defined as ≥ 20 min loss of
consciousness and/or > 24 hrs post-traumatic amnesia); or
17. Does not qualify for MRI scanning
- DBT-Only Group
1. Acute suicidal intent that requires hospitalization to protect harm to self
2. Any unstable medical and/or neurological condition
3. Currently pregnant or lactating, or intention to get pregnant during the duration
of the study
4. Any significant neurological disorder or condition likely to be associated with
increased intracranial pressure or cognitive impairment (e.g., a space occupying
brain lesion, a history of stroke, a cerebral aneurysm, a seizure disorder,
Parkinson's disease, Huntington's chorea, multiple sclerosis)
5. Medical condition, medication, or laboratory abnormality that could cause a major
depressive episode or significant cognitive impairment in the opinion of the
investigator (e.g., hypothyroidism with low TSH, rheumatoid arthritis requiring
high dose prednisone, or Cushing's disease)
6. Current diagnosis of delirium, dementia or another cognitive disorder secondary
to a general medical condition
7. Diagnosis of a developmental disorder (e.g. Down syndrome, autism-spectrum
disorder)
8. Non-correctable clinically significant sensory impairment (i.e., cannot hear or
see well enough to complete the neuropsychological tests)
9. Lower than eighth-grade reading level as assessed by the Wide Range Achievement
Test--Fourth Edition
10. Alcohol or substance use disorder (relating to opioids or cocaine use) currently
or within the past 1 month
11. Diagnosis of a DSM-5 psychotic disorder
12. Intracranial implant (e.g., aneurysm clips, shunts, stimulators, cochlear
implants, or electrodes) or any other metal object within or near the head,
excluding the mouth, that cannot be safely removed
13. Has sustained a moderate-to-severe head injury (defined as ≥ 20 min loss of
consciousness and/or > 24 hrs post-traumatic amnesia)
14. Does not qualify for MRI scanning
common.study.methods.has-drugs-no
common.study.methods.is-healthy-yes
