Brian Miller, MD, PhD, MPH. 

Dr. Miller, author of this educational activity, receives research support from Augusta University; the National Institute of Mental Health; the Brain and Behavior Research Foundation; and the Stanley Medical Research Institute. Relevant financial relationships listed for the author have been mitigated.

REVIEW OF: Medeiros GC et al, J Affect Disord 2021;291:39–45

STUDY TYPE: Longitudinal study

A history of childhood maltreatment (which includes abuse and neglect) is common in people with major depressive disorder and is associated with worse severity, chronicity, and recurrence of depression. What we don’t know is whether childhood maltreatment affects antidepressant response. Some studies show it reduces response rates, while others show it does not, and this study aimed to investigate this association.

This was a secondary analysis of the COMED trial, a large (n=663) randomized trial that compared escitalopram monotherapy with two antidepressant-combination groups (escitalopram plus bupropion and venlafaxine plus mirtazapine) in major depression over 12 weeks. Patients were not receiving depression-specific psychotherapy. Most were female (68%), mean age was 43, and 50% had a history of childhood maltreatment (based on a four-item self-report questionnaire). Depressive symptoms were evaluated with the clinician-rated Quick Inventory of Depressive Symptomatology.

After 12 weeks, patients with a history of childhood maltreatment had nonsignificantly greater reduction in depressive symptoms on antidepressants compared to those with more stable upbringings (-9.6 vs -8.2, p=0.20). However, patients subject to childhood maltreatment had significantly greater total side effect burden (p=0.01) throughout the trial. Patients with and without childhood maltreatment responded similarly to the three treatment arms (p=0.30). Dropout rates were similar in patients with and without childhood maltreatment (21% vs 19%). Response rates did not differ between patients with early maltreatment (before age 7) compared to later maltreatment. (Other studies have identified maltreatment before age 7 as a major risk factor for depression.)

As a secondary analysis, the trial was not designed to test the hypothesis in question, which is the main limitation here. Also, the analysis lacked detail about the intensity or duration of trauma, and about specific antidepressant-related side effects.

CARLAT TAKE

This study offers hope that patients with a history of childhood maltreatment can still respond to antidepressants, although they may experience more side effects on these medications.