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Adults with a history of childhood trauma may benefit from recommended treatments for depression, contrary to current theory – Neuroscience News

Summary: Patients with major depressive disorder who have experienced childhood trauma find improvement in symptoms after psychopharmacological intervention, psychotherapy, or a combination of both.

Source: The Lancet

Adults with major depressive disorder who have a history of childhood trauma show improvement in symptoms after pharmacotherapy, psychotherapy, or combination therapy.

The results of a new study published in The Lancet Psychiatrysuggest that contrary to current theory, these common treatments for major depressive disorder are effective for patients with childhood trauma.

Childhood trauma (defined as emotional/physical neglect or emotional/physical/sexual abuse before age 18) is known to be a risk factor for the development of major depressive disorder in later life. adulthood, often producing symptoms that appear earlier and last longer. more frequent recurrence and with an increased risk of morbidity.

Previous studies have suggested that adults and adolescents with childhood depression and trauma were about 1.5 times more likely to be unresponsive or to recover after drug therapy, psychotherapy, or combination therapy, than those without. childhood trauma.

“This study is the largest of its kind to examine the effectiveness of depression treatments for adults with childhood trauma and is also the first to compare the effect of active treatment with a control condition (waitlist , placebo or usual care) for this population.

“About 46% of adults with depression have a history of childhood trauma, and for people with chronic depression the prevalence is even higher. It is therefore important to determine whether current treatments offered for major depressive disorder are effective. for patients with childhood trauma,” says Ph.D. candidate and first author of the study, Erika Kuzminskaite.

The researchers used data from 29 clinical trials of pharmacotherapeutic and psychotherapeutic treatments for major depressive disorder in adults, covering a maximum of 6,830 patients. Of the participants, 4,268 or 62.5% reported a history of childhood trauma. Most clinical trials (15.51.7%) were conducted in Europe, followed by North America (9.31%). Measures of depression severity were determined using the Beck Depression Inventory (BDI) or the Hamilton Depression Rating Scale (HRSD).

The three research questions tested were: whether childhood trauma patients were more severely depressed before treatment, whether there were more adverse outcomes following active treatments for childhood trauma patients, and whether childhood trauma patients were less likely to benefit from active treatment than from a control state. .

Consistent with findings from previous studies, patients with childhood trauma showed greater symptom severity at the start of treatment than patients without childhood trauma, highlighting the importance of taking symptom severity into account when calculating treatment effects.

Although patients with childhood trauma reported more depressive symptoms at the start and end of treatment, they experienced similar improvement in symptoms compared to patients without a history of childhood trauma.

Treatment dropout rates were also similar for patients with and without childhood trauma. Measured treatment effectiveness did not vary by type of childhood trauma, diagnosis of depression, method of childhood trauma assessment, study quality, year, type of treatment, or duration.

“Finding that patients with depression and childhood trauma experience similar treatment outcomes to patients without trauma can give hope to people who have experienced childhood trauma. Nevertheless, residual symptoms after treatment in patients with childhood trauma warrant greater clinical attention, as additional interventions may still be required.

“To provide meaningful new advances and improve outcomes for people who have experienced childhood trauma, future research is needed to examine long-term treatment outcomes and the mechanisms by which childhood trauma exerts its lasting effects,” says Erika. Kuzminskaite.

Previous studies have suggested that adults and adolescents with childhood depression and trauma were about 1.5 times more likely to be unresponsive or to recover after drug therapy, psychotherapy, or combination therapy, than those without. childhood trauma. Image is in public domain

The authors acknowledge some limitations to this study, including a wide variety of results among the studies included in the meta-analysis, and all cases of childhood trauma being reported retrospectively.

The meta-analysis focused on symptom decline during the acute treatment phase, but people with depression and childhood trauma often have residual symptoms post-treatment and are characterized by a high risk of relapse, they may therefore receive much less treatment than patients without childhood trauma. long-term. The study design also did not take gender differences into account.

Writing in a linked comment, Antoine Yrondi, University of Toulouse, France (who was not involved in the research) said: “This meta-analysis may help convey a message of hope to patients with childhood trauma that the evidence-based psychotherapy and pharmacotherapy might improve depressive symptoms.

“However, physicians should keep in mind that childhood trauma may be associated with clinical features that may make it more difficult to achieve complete symptomatic remission and therefore impact functioning. daily.”

See also

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About this research on depression and child abuse

Author: Press office
Source: The Lancet
Contact: Press office – The Lancet
Image: Image is in public domain

Original research: Access closed.
“Efficacy and efficacy of treatment in adults with major depressive disorder and a history of childhood trauma: a systematic review and meta-analysis” by Erika Kuzminskaite et al. Lancet Psychiatry


Summary

Treatment effectiveness and efficacy in adults with major depressive disorder and a history of childhood trauma: a systematic review and meta-analysis

Background

Childhood trauma is a common and potent risk factor for developing major depressive disorder in adulthood, associated with earlier onset, more chronic or recurrent symptoms and a greater likelihood of having comorbidities . Some studies indicate that evidence-based pharmacotherapies and psychotherapies for depression in adults may be less effective in patients with a history of childhood trauma than in patients without childhood trauma, but the results are inconsistent. Therefore, we investigated whether people with major depressive disorder, including chronic forms of depression, and with a reported history of childhood trauma, had more severe depressive symptoms before treatment, had worse treatment outcomes unfavorable after active treatments and were less likely to benefit from active treatment. treatments versus a control condition, versus individuals with depression without childhood trauma.

Methods

We performed a full meta-analysis (PROSPERO CRD42020220139). The selection of studies combined the search of bibliographic databases (PubMed, PsycINFO and Embase) from November 21, 2013 to March 16, 2020 and full-text randomized clinical trials (RCTs) identified from several sources (from 1966 to 2016 -2019) to identify articles in English. RCTs and open-label trials comparing the effectiveness or efficacy of an evidence-based combination pharmacotherapy, psychotherapy, or intervention for adult patients with depressive disorders and the presence or absence of childhood trauma were included. Two independent researchers extracted the characteristics of the study. Group data for effect size calculations were requested from the study authors. The primary outcome was the change in depression severity between the start and end of the acute treatment phase, expressed as standardized effect size (Hedges g). Meta-analyses were performed using random-effects models.

Results

Of 10,505 publications, 54 trials met the inclusion criteria, of which 29 (20 RCTs and nine open-label trials) provided data on up to 6830 participants (age range 18-85 years, men and women and specific ethnic data not available). More than half (4268 [62%] of 6830) patients with major depressive disorder reported a history of childhood trauma. Despite more severe depression at baseline (g=0 202, 95% CI 0 145 to 0 258, I2= 0%), patients with childhood trauma received active treatment in the same way as patients without a history of childhood trauma (difference in treatment effect between groups g = 0 016, -0 094 to 0 125, I2=44 3%), with no significant difference in the effects of active treatment (versus control condition) between individuals with and without childhood trauma (childhood trauma g=0 605, 0 294 to 0 916, I2=58 0%; no childhood trauma g=0 178, –0 195 to 0 552, I2=67.5%; difference between groups p=0 051), and similar dropout rates (relative risk 1 063, 0 945 to 1 195, I2=0%). Results did not differ significantly by type of childhood trauma, study design, diagnosis of depression, method of childhood trauma assessment, study quality, year or type or duration of treatment, but differed by country (North American studies showed larger treatment effects for patients with childhood trauma; corrected false discovery rate p=0 0080 ). Most studies were at moderate to high risk of bias (21 [72%] of 29), but sensitivity analysis in low-bias studies yielded results similar to those obtained when all studies were included.

Interpretation

Unlike previous studies, we found evidence that the symptoms of patients with major depressive disorder and childhood trauma improved significantly after pharmacological and psychotherapeutic treatments, despite the higher severity of their depressive symptoms. . Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder, regardless of their childhood traumatic condition.

Funding

None.

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