title: Impact of physical and sexual abuse on treatment response in the Treatment of Resistant Depression in Adolescent Study (TORDIA).
abstract: OBJECTIVE
  We previously reported that a history of abuse was associated with a poorer response to combination treatment in the Treatment of Resistant Depression in Adolescents study (TORDIA). We now report on the nature and correlates of abuse that might explain these findings.
  
  
  METHODS
  Youth who did not benefit from an adequate selective serotonin re-uptake inhibitor (SSRI) trial (N = 334) were randomized to one of the following: an alternative SSRI; an alternative SSRI plus cognitive behavior therapy (CBT); venlafaxine; or venlafaxine plus CBT. Analyses examined the effect of history of abuse on response to the pharmacotherapy and combination therapy.
  
  
  RESULTS
  Those without a history of physical abuse (PA) or sexual abuse (SA) had a higher 12-week response rate to combination therapy compared with medication mono-therapy (62.8% versus 37.6%; odds ratio [OR] = 2.8, 95% confidence interval [CI] = 1.6-4.7, p < .001). Those with a history of SA had similar response rates to combination versus medication monotherapy (48.3% versus 42.3%; OR = 1.3, 95% CI = 0.4-3.7; p = .66), whereas those with history of PA had a much lower rate of response to combination therapy (18.4% versus 52.4%, OR = 0.1; 95% CI = 0.02-0.43). Even after adjusting for other clinical predictors, a history of PA moderated treatment outcome.
  
  
  CONCLUSIONS
  These results should be considered within the limitations of a post hoc analysis, lack of detailed assessment of abuse and other forms of trauma, and neuropsychological status. Depressed patients with history of abuse, especially PA may require specialized clinical approaches. Further work is needed to understand by what mechanisms a history of abuse affects treatment response.
authors.affiliation: Rosalind Franklin University of Medicine and Sciences, North Chicago, IL, USA.
authors.forename: Wael
authors.initials: W
authors.lastname: Shamseddeen
authors.forename: Joan Rosenbaum
authors.initials: JR
authors.lastname: Asarnow
authors.forename: Gregory
authors.initials: G
authors.lastname: Clarke
authors.forename: Benedetto
authors.initials: B
authors.lastname: Vitiello
authors.forename: Karen Dineen
authors.initials: KD
authors.lastname: Wagner
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: Martin B
authors.initials: MB
authors.lastname: Keller
authors.forename: Graham
authors.initials: G
authors.lastname: Emslie
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
authors.forename: Neal D
authors.initials: ND
authors.lastname: Ryan
authors.forename: James T
authors.initials: JT
authors.lastname: McCracken
authors.forename: Giovanna
authors.initials: G
authors.lastname: Porta
authors.forename: Taryn
authors.initials: T
authors.lastname: Mayes
authors.forename: David A
authors.initials: DA
authors.lastname: Brent
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003863:Depression / Q000209:etiology / Q000523:psychology / Q000628:therapy; D003865:Major Depressive Disorder / Q000209:etiology / Q000523:psychology / Q000628:therapy; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D007406:Interview, Psychological; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D059020:Suicidal Ideation; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors