The impact of childhood maltreatment on the differential efficacy of CBASP versus escitalopram in patients with chronic depression: A secondary analysis.
Childhood maltreatment (CM) has been indicated as a predictor of a differential response to antidepressant treatment with psychotherapy compared to medication. In this secondary analysis, we investigated whether the presence of CM results in a differential indication for the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or escitalopram plus clinical management (ESC). Sixty patients with chronic depression were randomized to either 22 sessions of CBASP or ESC over the course of 8 weeks of acute and 20 weeks of extended treatment at 2 German treatment sites. CM was assessed using the Childhood Trauma Questionnaire and the clinician rated Early Trauma Inventory. Intention-to-treat analyses were used to examine the impact of CM on depression, global functioning, and quality of life. The presence of CM did not result in significant differences in treatment response to CBASP or ESC on any outcome measure after 28 weeks of treatment independent of the type of CM assessment. After 8 weeks, a significant CM × treatment interaction was found for scores on the Montgomery-Asberg Depression Rating Scale. Patients with a history of CM receiving CBASP had a significantly lower response rate compared to patients without CM and to those receiving ESC after 8 weeks. Conclusively, CBASP and ESC are equally effective treatment options for the difficult to treat subgroup of patients with chronic depression and a history of CM. CM may be a predictor of a longer latency of treatment response in the case of psychotherapy.


CONCLUSIONS
CBASP and escitalopram are equally effective treatment options for chronic depression. Both treatments are also equally effective for the difficult to treat subgroup of patients with chronic depression and a history of childhood maltreatment. Childhood maltreatment may result in a longer latency of treatment response in the case of psychotherapy.
Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Paul
http://orcid.org/0000-0003-0484-9143
P
Bausch
Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Thomas
T
Fangmeier
Psychology School, Fresenius University of Applied Sciences Berlin, Berlin, Germany.
Ingo
I
Zobel
Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.
Dieter
D
Schoepf
Psychology School, Fresenius University of Applied Sciences Cologne, Cologne, Germany.
Sarah
S
Drost
Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.
Knut
K
Schnell
Department of Psychiatry and Psychotherapy, University Medical Center Charité Berlin, Berlin, Germany.
Henrik
H
Walter
Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Mathias
M
Berger
Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Claus
C
Normann
Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Elisabeth
E
Schramm
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D002648:Child; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data*; D002908:Chronic Disease; D015283:Citalopram / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram
Childhood Maltreatment; Chronic Depression; Cognitive Behavioral Analysis System of Psychotherapy; Escitalopram; Medication; Psychotherapy