While there are few reliable predictors of which people will respond
to specific antidepressants, lots of previous research links a
history of trauma early in life with how well people tend to do on
these drugs, researchers note in the journal Translational
"The presence of trauma history should be taken into account when
making treatment decisions," said Leanne Williams of Stanford
University and the VA Palo Alto Health Care System in California,
lead author of the new study.
"Based on our findings, if you have experienced abuse or neglect
early in life you are 1.6 times less likely to benefit from a
typical first line antidepressant than a person who hasn't had this
experience," Williams said by email. "In this case, consideration
should be given to alternative medications plus adjunctive therapies
that address the trauma issues as well as the current experience of
To see how common childhood trauma is among depressed patients,
Williams and her team compared 1,000 people diagnosed with major
depression to 336 similar people who didn't have depression. They
also looked at how each of the patients with depression responded to
eight weeks of treatment with one of three randomly assigned
antidepressants – escitalopram (Lexapro), sertraline (Zoloft) or
extended release venlafaxine (Effexor).
Childhood trauma was much more common among the depressed adults,
with about 63 percent reporting two or more experiences of either
childhood abuse, neglect, loss of a parent or sibling, exposure to
domestic violence, family breakup, severe health crisis, or some
other significant violence or loss in childhood. Roughly 28 percent
of people in the healthy control group reported two or more such
About 22 percent of the people with depression in the study, and 5
percent of the healthy controls said they had experienced some type
of physical abuse during childhood.
Sexual abuse occurred during childhood for 16 percent of the
depressed participants and 5 percent of the controls.
Depressed patients in the study were also four times more likely to
report a history of emotional abuse – 43 percent of them experienced
this compared with 9 percent of the controls.
In addition, 41 percent of the depressed participants and 31 percent
of the control group said their parents divorced or separated during
Overall, the presence of one traumatic event of any kind was not
linked to whether depressed patients saw symptom improvements after
eight weeks on antidepressants.
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A specific history of physical, sexual or emotional abuse, however -
particularly if it occurred at age 7 or younger - was associated
with a worse response to the drugs, the study found.
By the end of the treatment period, only about 18 percent of
depressed participants with a history abuse from age 4 to 7
experienced at least a 50 percent reduction in depression symptoms
and just 16 percent achieved remission.
In contrast, among patients with no history of abuse, 82 percent saw
symptom severity cut in half and 84 percent achieved remission.
Globally, about 405 million people experience depression, and less
than half of patients with severe depression achieve remission from
One limitation of the study is its reliance on adults to accurately
recall and report on trauma that happened during early childhood,
the authors note. The study also only looked at three
antidepressants and the findings might be different with other
Even so, the study adds to growing body of evidence showing that
childhood trauma is associated with an increased risk for a variety
of mental health disorders including depression, said Dr. Katie
McLaughlin, a psychology researcher at the University of Washington
in Seattle who wasn’t involved in the study.
“This study suggests that child maltreatment and trauma not only
predict greater likelihood of developing depression and a more
chronic course of depression, but also reduced likelihood of
responding to antidepressant medication treatment,” McLaughlin said
SOURCE: http://bit.ly/1TSPead Translational Psychiatry, online May
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