title: A history of early life parental loss or separation is associated with successful cognitive-behavioral therapy in major depressive disorder.
abstract: BACKGROUND
  There is a clinical need for evidence-based psychotherapy response biomarkers in major depressive disorder (MDD). Based on previous studies, we hypothesized that lower 24-h urinary cortisol levels and a history of early life stress/trauma would predict an improved antidepressant response to cognitive-behavioral therapy (CBT).
  
  
  METHODS
  50 currently depressed MDD subjects were enrolled. 24-h urine was collected and measured for cortisol levels by radioimmunoassay (RIA). Subjects were also administered early life stress/trauma measures at baseline: Global Perceived Early-Life Stress (GPELS), The Early Life Trauma Inventory (ELTI) and Klein Loss Scale (KLS). The efficacy of a twelve-week course of once-weekly CBT was evaluated by the primary outcome measure, the 24-item Hamilton Depression Rating Scale (HDRS24), at baseline and every four weeks, and the Beck Depression Inventory at baseline and weekly thereafter. 42 subjects had at least one complete follow-up visit (≥4 weeks of CBT), and 30 subjects completed the full 12-week course.
  
  
  RESULTS
  Baseline 24-h urinary cortisol levels did not correlate with CBT's antidepressant response. Higher KLS scores, a measure of early life parental loss or separation, correlated with delta HDRS24 (rs=-0.39, padjusted=0.05). Complementary general linear model analysis revealed enhanced CBT efficacy in patients with a history of early life parental loss or separation [F(1,35)=6.65, p=0.01].
  
  
  CONCLUSIONS
  Small sample size, Treatment-naïve population.
  
  
  CONCLUSIONS
  Early life parental separation or loss positively correlated with CBT's antidepressant efficacy in our sample and may warrant further study in larger clinical samples.
authors.affiliation: National Institutes of Health, National Institute of Mental Health, Experimental Therapeutics and Pathophysiology Branch, Building 10/CRC, 10 Center Dr., Bethesda, MD 20892, USA. Electronic address: mark.niciu@nih.gov.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Niciu
authors.affiliation: Yale University Department of Psychiatry/Connecticut Mental Health Center, Abraham Ribicoff Research Facilities, 34 Park St., 3rd floor, New Haven, CT 06519, USA; Clinical Neuroscience Division, Veterans Affairs National Center for PTSD, Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, USA.
authors.forename: Chadi G
authors.initials: CG
authors.lastname: Abdallah
authors.affiliation: Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Fenton
authors.affiliation: Yale University Department of Psychiatry/Connecticut Mental Health Center, Abraham Ribicoff Research Facilities, 34 Park St., 3rd floor, New Haven, CT 06519, USA.
authors.forename: Madonna K
authors.initials: MK
authors.lastname: Fasula
authors.affiliation: Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Black
authors.affiliation: Yale Child Study Center, 230 South Frontage Rd., New Haven, CT 06519, USA.
authors.forename: George M
authors.initials: GM
authors.lastname: Anderson
authors.affiliation: Yale University Department of Psychiatry/Connecticut Mental Health Center, Abraham Ribicoff Research Facilities, 34 Park St., 3rd floor, New Haven, CT 06519, USA.
authors.forename: Gerard
authors.initials: G
authors.lastname: Sanacora
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000378:metabolism / Q000628:therapy*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011863:Radioimmunoassay; D012463:Saliva / Q000737:chemistry / Q000378:metabolism*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D006854:Hydrocortisone
keywords: Cognitive-behavioral therapy; Cortisol; Hypothalamic-pituitary-adrenal axis; Major depressive disorder; Parental loss; Parental separation