Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma

Abstract

Major depressive disorder is associated with considerable morbidity, disability, and risk for suicide. Treatments for depression most commonly include antidepressants, psychotherapy, or the combination. Little is known about predictors of treatment response for depression. In this study, 681 patients with chronic forms of major depression were treated with an antidepressant (nefazodone), Cognitive Behavioral Analysis System of Psychotherapy (CBASP), or the combination. Overall, the effects of the antidepressant alone and psychotherapy alone were equal and significantly less effective than combination treatment. Among those with a history of early childhood trauma (loss of parents at an early age, physical or sexual abuse, or neglect), psychotherapy alone was superior to antidepressant monotherapy. Moreover, the combination of psychotherapy and pharmacotherapy was only marginally superior to psychotherapy alone among the childhood abuse cohort. Our results suggest that psychotherapy may be an essential element in the treatment of patients with chronic forms of major depression and a history of childhood trauma.

Childhood maltreatment predicts adult inflammation in a life-course study

“…Although, for example, improvements in socioeconomic condition and in IQ remain a largely unmet target, effective preventive strategies exist for maltreatment (28). Therapeutic interventions including psychological and pharmacological treatment also might reverse the long-lasting effects of maltreatment (29,30). Third, childhood maltreatment is a pleiotropic risk factor influencing multiple pathophysiological pathways and outcomes [e.g., psychiatric disorders (31), health behaviors (19), and crime (12)].…”

Subtyping Major Depressive Disorder

“…Recent research suggests that the dexamethasone/CRF test may reveal elevated cortisol and ACTH levels only in those depressed individuals who have also suffered severe stress in childhood [19]. Nemeroff et al [20] reported that such patients respond to cognitive-behavioral therapy better than to an antidepressant. …”

Overcoming Treatment Resistance in Chronic Depression: A Pilot Study on Outcome and Feasibility of the Cognitive Behavioral Analysis System of Psychotherapy as an Inpatient Treatment Program

“…It integrates cognitive-emotional, behavioral, interpersonal, and psychodynamic/psychoanalytical theories and strategies across schools by directly addressing the specific psychopathology. In most of the outpatient studies CBASP proved to be an effective treatment, especially in combination with medication [3], in patients with childhood trauma [4], early onset [5], and with a long duration of treatment [6]. One study found no difference between CBASP, supportive therapy, or optimized pharmacotherapy as an augmentation strategy of medication partial response or nonresponse [7].…”