Differential Responses to Psychotherapy Versus Pharmacotherapy in Patients With Chronic Forms of Major Depression and Childhood Trauma

Nemeroff, Charles B.; Heim, Christine; Thase, Michael E.; Klein, Daniel N.; Rush, A. John; Schatzberg, Alan F.; Ninan, Philip T.; McCullough, James P.; Weiss, Paul; Dünner, David L.; Rothbaum, Barbara O.; Kornstein, Susan G.; Keitner, Gabor I.; Keller, Martin B.

doi:10.1176/foc.3.1.131

Cited by 179 publications

(232 citation statements)

References 13 publications

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“…40 In this other landmark study, 681 chronically depressed patients were treated with either pharmacotherapy (nefazodone), psychotherapy (Cognitive Behavioral System of Psychotherapy, CBASP), or a combination thereof. 41 Overall, patients responded more favorably to the treatment combination than to either treatment in isolation. However, in the subset of patients with a history of childhood trauma, psychotherapy was clearly superior to antidepressant monotherapy, and the combination provided little added benefit.…”

Section: Strengthsmentioning

confidence: 96%

Childhood trauma and dimensions of depression: a specific association with the cognitive domain

Vares

Salum

Spanemberg

et al. 2015

Rev. Bras. Psiquiatr.

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Objective: To investigate associations between a history of childhood trauma and dimensions of depression in a sample of clinically depressed patients. Methods: A sample of 217 patients from a mood-disorder outpatient unit was investigated with the Beck Depression Inventory, the Hamilton Depression Rating Scale, the CORE Assessment of Psychomotor Change, and the Childhood Trauma Questionnaire. A previous latent model identifying six depressive dimensions was used for analysis. Path analysis and Multiple Indicators Multiple Causes (MIMIC) models were used to investigate associations between general childhood trauma and childhood maltreatment modalities (emotional, sexual, and physical abuse; emotional and physical neglect) with dimensions of depression (sexual, cognition, insomnia, appetite, non-interactiveness/ retardation, and agitation). Results: The overall childhood trauma index was uniquely associated with cognitive aspects of depression, but not with any other depressive dimension. An investigation of childhood maltreatment modalities revealed that emotional abuse was consistently associated with depression severity in the cognitive dimension. Conclusion: Childhood trauma, and specifically emotional abuse, could be significant risk factors for the subsequent development of cognitive symptoms of major depression. These influences might be specific to this depressive dimension and not found in any other dimension, which might have conceptual and therapeutic implications for clinicians and researchers alike.

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Section: Strengthsmentioning

confidence: 96%

Childhood trauma and dimensions of depression: a specific association with the cognitive domain

Vares

Salum

Spanemberg

et al. 2015

Rev. Bras. Psiquiatr.

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show abstract

“…Firstly, in a large randomized controlled trial, a history of childhood trauma predicted a better response to psychological treatment and a worse response to pharmacotherapy. 76 As childhood trauma is more likely to be involved in the development of depression in carriers of environmentally sensitive genotypes, 3,16 5-HTTLPR short allele and BDNF 66met allele carriers are likely to have been overrepresented among depressed individuals reporting a history of childhood trauma. Consequently, the G Â E (rather than childhood trauma alone) may be the true determinant of differential response to psychological and pharmacological intervention.…”

Section: Can Cause Inform Cure?mentioning

confidence: 99%

The implications of gene–environment interactions in depression: will cause inform cure?

Uher

2008

Mol Psychiatry

134

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In a number of human diseases, including depression, interactions between genetic and environmental factors have been identified in the absence of direct genotype-disorder associations. The lack of genes with major direct pathogenic effect suggests that genotype-specific vulnerabilities are balanced by adaptive advantages and implies aetiological heterogeneity. A model of depression is proposed that incorporates the interacting genetic and environmental factors over the life course and provides an explanatory framework for the heterogeneous aetiology of depression. Early environmental influences act on the genome to shape the adaptability to environmental changes in later life. The possibility is explored that genotype-and epigenotype-related traits can be harnessed to develop personalized therapeutic interventions. As diagnosis of depression alone is a weak predictor of response to specific treatments, aetiological subtypes can be used to inform the choice between treatments. As a specific application of this notion, a hypothesis is proposed regarding relative responsiveness of aetiological subtypes of depression to psychological treatment and antidepressant medication. Other testable predictions are likely to emerge from the general framework of interacting genetic, epigenetic and environmental mechanisms in depression.

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“…In a carefully designed randomized controlled trial of medication and psychotherapy for chronic depression, Nemeroff et al (2003) found that childhood trauma had a signifi cant impact on the response to treatment. The study compared the effects of a form of cognitive therapy alone with an antidepressant (nefazodone).…”

Section: Childhood Traumamentioning

confidence: 99%

The impact of personality and personality disorders on the treatment of depression

Gabbard

Simonsen

2007

Personality & Mental Health

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Differential Responses to Psychotherapy Versus Pharmacotherapy in Patients With Chronic Forms of Major Depression and Childhood Trauma

Cited by 179 publications

References 13 publications

Childhood trauma and dimensions of depression: a specific association with the cognitive domain

Childhood trauma and dimensions of depression: a specific association with the cognitive domain

The implications of gene–environment interactions in depression: will cause inform cure?

The impact of personality and personality disorders on the treatment of depression

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