Early adversity in chronic depression: clinical correlates and response to pharmacotherapy.
BACKGROUND
There is growing evidence suggesting that early adversity may be a marker for a distinct pathway to major depressive disorder (MDD). We examined associations between childhood adversity and a broad variety of clinical characteristics and response to pharmacotherapy in a large sample of patients with chronic forms of MDD.


METHODS
Subjects included 808 patients with chronic forms of MDD (chronic MDD, double depression, or recurrent MDD with incomplete recovery between episodes and a total continuous duration of >2 years) who were enrolled in a 12-week open-label trial of algorithm-guided pharmacotherapy. Baseline assessments included a semi-structured diagnostic interview, and clinician- and self-rated measures of depressive symptoms, social functioning, depressotypic cognitions, and personality traits, and childhood adversity. Patients were re-evaluated every 2 weeks.


RESULTS
A longer duration of illness; earlier onset; greater number of episodes, symptom severity, self-rated functional impairment, suicidality, and comorbid anxiety disorder; and higher levels of dysfunctional attitudes and self-criticism were each associated with multiple forms of childhood adversity. A history of maternal overcontrol, paternal abuse, paternal indifference, sexual abuse, and an index of clinically significant abuse each predicted a lower probability of remission. Among patients completing the 12-week trial, 32% with a history of clinically significant abuse, compared to 44% without such a history, achieved remission.


CONCLUSIONS
These findings indicate that a history of childhood adversity is associated with an especially chronic form of MDD that is less responsive to antidepressant pharmacotherapy.
Department of Psychology, State University of New York at Stony Brook, Stony Brook, New York 11794-2500, USA. daniel.klein@stonybrook.edu
Daniel N
DN
Klein
Bruce A
BA
Arnow
Jennifer L
JL
Barkin
Frank
F
Dowling
James H
JH
Kocsis
Andrew C
AC
Leon
Rachel
R
Manber
Barbara O
BO
Rothbaum
Madhukar H
MH
Trivedi
Stephen R
SR
Wisniewski
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000465:Algorithms; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D016642:Bupropion / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis / Q000523:psychology; D002908:Chronic Disease; D015283:Citalopram / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D003511:Cyclohexanols / Q000009:adverse effects / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008803:Mianserin / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D016487:Parenting / Q000523:psychology; D012307:Risk Factors; D012649:Self Concept; D020280:Sertraline / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride; D055815:Young Adult
D000928:Antidepressive Agents; D003511:Cyclohexanols; D003692:Delayed-Action Preparations; D016642:Bupropion; D015283:Citalopram; D008803:Mianserin; D000069470:Venlafaxine Hydrochloride; D000078785:Mirtazapine; D020280:Sertraline