Byline: Deborah A. Lott
A number of studies have established that early life trauma increases one's risk of developing depression later in life (Dube et al., 2001; Heim and Nemeroff, 2001; Kendler et al., 1995). Whether the depression that develops following a traumatic childhood is distinct in any neurobiological or other respect from depression in the absence of such a history has been an open question. Also unanswered is the question of how an adverse childhood history might affect the treatment response of a patient with depression. A recent analysis of data from a large multisite investigation of 681 subjects with chronic depression found that patients with childhood trauma histories responded significantly differently to treatment than did patients with chronic depression without traumatic pasts (Nemeroff et al., 2003). For patients with chronic depression who had experienced serious childhood adversities such as the loss of a parent by the age of 15, physical or sexual abuse, or neglect, 12 weeks of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) provided significantly better results than did 12 weeks of treatment with the antidepressant nefazodone (Serzone). Combination treatment was only marginally superior to psychotherapy alone for this group of patients. Thus, for patients with chronic depression with a history of childhood trauma, psychotherapy was the crucial element in recovery.
These findings were in stark contrast to the previously published main analysis of the entire group of patients, which found that treatment with either medication or psychotherapy was about equally effective and that combination therapy was significantly better than either monotherapy (Keller et al., 2000). In that analysis, about half of the 519 subjects (out of the original 681) who completed the trial responded to either 12 weeks of treatment with nefazodone (55% response rate) or psycho-therapy (52% response rate). A full 85% of subjects responded to combination treatment. Response was defined as a reduction in the 24-item Hamilton Rating Scale for Depression (HAM-D-24) by at least 50% from baseline and a score lesser than or equal to 15. In terms of remission (defined as an exit HAM-D-24 score lesser than or equal to 8), 24% of patients treated with psychotherapy achieved remission versus 22% of those treated with nefazodone. Significantly more patients achieved remission during combination treatment (42%) than with either monotherapy.
For the data published in the 2003 report, the researchers went back to the original data set to see how the results might shift if stratified according to the presence or absence of childhood trauma. Charles Nemeroff, M.D., Ph.D., Reunette W. Harris Professor and chairperson of the department of psychiatry and behavioral sciences at the Emory University School of Medicine, has developed a large body of findings that suggest that adverse experiences may change the function and even some anatomical features of the developing brain. "There are many neurobiological consequences of early life trauma," he told Psychiatric Times in an interview. "We conceptualize psychotherapy to be a biological treatment just as are antidepressants but they clearly target different parts of the...