Ketamine for Borderline Personality Disorder: A Promising Step Toward Functional Recovery

Living with Borderline Personality Disorder (BPD) can feel like being caught in a storm that never lets up. Intense emotions, fear of abandonment, suicidal thoughts, and unstable relationships can make daily life feel overwhelming. At Philadelphia Integrative Psychiatry, we understand how exhausting this can be—not just for those living with BPD, but also for their loved ones. That’s why Dr. David Danish and our team remain committed to staying on the cutting edge of emerging treatments, particularly those that offer fast, meaningful relief.

One treatment we're closely following is ketamine. Though it's best known as an anesthetic—and more recently, as a rapid-acting intervention for treatment-resistant depression—its use in BPD has remained largely unexplored. Until now.

A recent pilot study titled “A pilot randomized controlled trial of ketamine in Borderline Personality Disorder” sheds new light on this possibility. The trial examined how a single ketamine infusion might affect mood, suicidal ideation, and daily functioning in adults with BPD. It’s a small study, but a hopeful one—especially given the lack of FDA-approved medications for BPD.

What the Study Found

In this study, 22 adults diagnosed with BPD and experiencing active suicidal thoughts were randomly assigned to receive either a single dose of ketamine (0.5 mg/kg intravenously over 40 minutes) or a control dose of midazolam (0.04 mg/kg IV), a mild sedative commonly used in psychiatric research. Participants were evaluated over the following 28 days using a range of validated clinical tools that measured suicidality, depression, anxiety, BPD symptom severity, and social functioning.

Both groups showed significant decreases in suicidal ideation by Day 3, as measured by the Beck Scale for Suicide Ideation (p < 0.001). This dramatic improvement suggests that the therapeutic structure of the study itself—marked by clinical monitoring and supportive care—may have had a meaningful impact, regardless of which medication was received.

Depressive symptoms also improved significantly across the board, with both groups reporting better mood by Day 3. While the ketamine group did not show a statistically significant advantage over midazolam in this area, it did trend toward a greater reduction in depression scores (Cohen’s d = 0.18), suggesting that ketamine may still provide a faster route to relief for some individuals—especially those with acute or treatment-resistant depression.

Anxiety and core BPD symptoms also improved over the course of the study in both groups. While these changes weren’t unique to ketamine, they are still encouraging given how challenging these symptoms can be to treat.

Where ketamine truly stood out was in improving day-to-day, real-world functioning. By Day 14, participants who received ketamine showed significantly greater gains in socio-occupational functioning, as measured by the Social Adjustment Scale (p = 0.03, ηp² = 0.20). This is particularly noteworthy because improvements in functioning are often harder to achieve than symptom reduction—and they tend to be the most meaningful in terms of quality of life. The study also found that improvements in functioning were strongly correlated with improvements in depression (r = 0.65), suggesting that ketamine’s mood-enhancing effects may help patients re-engage with work, relationships, and everyday responsibilities.

Safety & Tolerability

Importantly, ketamine was generally well-tolerated, even among participants with a history of dissociation—a common concern in BPD. No serious adverse events were reported. Some individuals did experience dissociative symptoms during the infusion, more frequently than in the control group, but these resolved within 40 minutes for all participants.

Additional side effects reported in the ketamine group included vivid dreams (experienced by up to 60% of participants by Day 14), mild nausea, and blurry vision. Most of these effects were transient and mild, reinforcing the overall safety of ketamine in this population.

What This Means for the Future of BPD Treatment

At Philadelphia Integrative Psychiatry, we often see how difficult it can be for patients with BPD to access consistent, effective care. Long waits for therapy, limited insurance coverage, and partial medication responses can leave people feeling stuck. That’s why research like this matters.

Ketamine isn’t a cure—but it may one day serve as a bridge to deeper healing, helping patients stabilize enough to fully engage in therapy, reconnect with others, and regain a sense of control over their lives.

If you or someone you care about is struggling with BPD, emotional volatility, or suicidal thoughts, we want you to know: help exists, and healing is possible. Our team offers thorough diagnostic evaluations, evidence-based psychotherapy, and a commitment to integrating promising treatments—like ketamine—into personalized care plans.

To learn more, or to schedule a consultation, visit us at Philadelphia Integrative Psychiatry.