Anticipating suicide act of patient with borderline personality disorder and history of severe depression

Introduction: Suicide as a complication of depression is often caused by two main feelings, helplessness and hopelessness. Patients with borderline personality disorder (BPD) experience these two emotional conditions for a long time in their lifetime, which makes them self-harm quite often. They need another person as a "holding environment", including their caregiver or doctor. This case study aims to assess how influential the role of medical personnel and pharmacotherapy is on the management of suicide in patients with BPD with a history of major depression.Case Description: Depression has multifaceted symptoms, including feeling sad, confused thoughts, hopelessness, reduced concentration, loss of interest in doing things, reduced self-esteem and self-confidence, decreased appetite, difficulty breathing, sleeping, contemplating suicide, and eventually attempting suicide. This patient's dynamics illustrate that suicide is often the last peak of her depressive state, however impulsive she may be with her BPD. The patient experiences a preoccupation with helplessness, that she no longer deserves to live and is no longer able to face the problems she faces. Her meeting with her doctor made her feel recognized that her feelings were valid, and not try to deny what she was feeling. The patient received treatment with fluoxetine 20mg tab and felt that the medicine she was taking was not a "punishment" for her illness, but a way of healing. The patient felt that from the beginning of treatment until now, she admitted that she had never thought about committing suicide again.Conclusion: The combination of pharmacotherapy with psychotherapy is more effective in anticipating this risk of suicide, and preventing relapse or recurrence of depression, compared to pharmacotherapy or psychotherapy alone.