Adults with depression and a history of childhood trauma respond as well to medications and psychotherapy as those without childhood trauma, according to a meta-analysis published in Lancet Psychiatry.
“Several individual and meta-analytic studies indicate that a history of childhood trauma is associated with poorer response to first-line depression treatments, suggesting the need for new personalised treatments for patients with major depressive disorder and childhood trauma,” wrote Erika Kuzminskaite, M.S., of Vrije University in the Netherlands and colleagues with the Childhood Trauma Meta-Analysis Study Group. “However, the evidence on poorer treatment outcomes in adults with depression and childhood trauma has not been definitive.”
Kuzminskaite and colleagues collected data from 29 randomized clinical trials testing a medication, psychotherapy, or combination treatment for adults with major depression; all trials included assessments for childhood trauma. The combined samples included 6,830 adults, of whom 62% had reported a history of childhood trauma. Although adults with a history of childhood trauma on average had more severe depressive symptoms at baseline, they had similar symptom improvement following treatment as adults with no trauma history. The findings were consistent regardless of depression type (depression or treatment-resistant depression), treatment type (medication or psychotherapy), or trauma type (emotional, physical, or sexual abuse or neglect).
Kuzminskaite and colleagues noted that previous studies in this area typically looked at treatment response or depression remission as the outcomes. “Subsequently, greater improvement could be required for patients with childhood trauma to meet the definition of remission,” they wrote. “By contrast, we examined depression severity change from baseline to after treatment consistently taking baseline symptoms into account and using depression severity correlations from before and after treatment.”
“This meta-analysis delivers a hopeful message to patients with childhood trauma that evidence-based psychotherapy and pharmacotherapy could improve depressive symptoms,” wrote Antoine Yrondi, M.D., Ph.D., of the University of Toulouse, France, in an accompanying editorial. “However, physicians should keep in mind that childhood trauma could be associated with clinical features which might make it more difficult to reach complete symptomatic remission of major depressive disorder and, therefore, have an effect on daily functioning.”
For related information, see Prospective Study Delves Deeper Into Mental Health Effects of Childhood Trauma.
(Image: iStock/lithiumcloud)
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