Clinical characteristics and treatment outcome of depression in patients with and without a history of emotional and physical abuse

Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, School of Medicine, University of Pisa, Italy.
Journal of Psychiatric Research (Impact Factor: 3.96). 10/2009; 44(5):302-9. DOI: 10.1016/j.jpsychires.2009.09.008
Source: PubMed


Clinical features and treatment outcome were compared in depressed outpatients with and without a history of emotional and physical abuse (EPA), including childhood maltreatment. Patients were initially randomized to IPT or SSRI and then augmented with the second treatment if they did not remit with monotherapy. Assessments included the SCID-I, the SCID-II for DSM-IV diagnoses, the HRSD, the QIDS and the Mood Spectrum Self-Report (MOODS-SR). Seventy-eight (25%) patients reported a history of EPA; 60 (76.9%) were women. Patients with a history of EPA did not differ from those without on HRSD scores at baseline, but showed an earlier age at onset of depression and a longer duration of illness. The two groups differed on several mood spectrum factors, namely: 'depressivemood' (15.6+/-4.9 vs. 13.5+/-5.4; p<0.004), 'psychomotorretardation' (11.7+/-4.5 vs. 9.6+/-4.7; p<0.001), 'drugandillness-relateddepression' (1.3+/-1.3 vs. 0.6+/-1.0; p<0.0001), and 'neurovegetativesymptoms' (8.3+/-2.6 vs. 6.9+/-2.9; p<0.0001). Patients with EPA had also a significantly longer time to remission (89 vs. 67days, log-rank test, p=0.035). The need for augmentation treatment was significantly more frequent among patients with EPA than in those without. The present study suggests that patients with a history of EPA show a subtype of depression characterized by poor treatment response and more severe neurovegetative and psychomotor symptoms.

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Available from: Paola Rucci, Oct 04, 2015
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    • "A corpus of preclinical and clinical studies has firmly established that early life neglect or abuse is associated with dramatic increase in the risk to develop depression [Chapman et al., 2004; Heim and Nemeroff, 2001; Hill et al., 2001; Spatz Widom et al., 2007]. Moreover, early life stress can also have influence on nearly all aspects of the disease process including manifestation of symptoms, frequency of recurrence or relapse after a period of remission, and responses to pharmacotherapy [Angst et al., 2011; Klein et al., 2009; Miniati et al., 2010; Nanni et al., 2012]. "
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    ABSTRACT: Many studies have suggested that childhood maltreatment increase risk of adulthood major depressive disorder (MDD) and predict its unfavorable treatment outcome, yet the neural underpinnings associated with childhood maltreatment in MDD remain poorly understood. Here, we seek to investigate the whole-brain functional connectivity patterns in MDD patients with childhood maltreatment. Resting-state functional magnetic resonance imaging was used to explore intrinsic or spontaneous functional connectivity networks of 18 MDD patients with childhood neglect, 20 MDD patients without childhood neglect, and 20 healthy controls. Whole-brain functional networks were constructed by measuring the temporal correlations of every pairs of brain voxels and were further analyzed by using graph-theory approaches. Relative to the healthy control group, the two MDD patient groups showed overlapping reduced functional connectivity strength in bilateral ventral medial prefrontal cortex/ventral anterior cingulate cortex. However, compared with MDD patients without a history of childhood maltreatment, those patients with such a history displayed widespread reduction of functional connectivity strength primarily in brain regions within the prefrontal-limbic-thalamic-cerebellar circuitry, and these reductions significantly correlated with measures of childhood neglect. Together, we showed that the MDD groups with and without childhood neglect exhibited overlapping and segregated functional connectivity patterns in the whole-brain networks, providing empirical evidence for the contribution of early life stress to the pathophysiology of MDD. Hum Brain Mapp, 2013. © 2013 Wiley Periodicals, Inc.
    Human Brain Mapping 04/2014; 35(4). DOI:10.1002/hbm.22241 · 5.97 Impact Factor
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    • "According to the literature, early life stress (ELS), such as child abuse, neglect, or parental loss, has been associated with significant increase in the risk of developing depression in adulthood (2–5). Recent studies show that ELS can also influence the clinical course and a poorer treatment outcome of depression (6, 7). Child abuse and neglect can be perceived as agents for neurodevelopment disturbance and, depending on when it occurs, can cause neurological “scars” in some structures, which could make some individuals vulnerable to certain types of psychopathology, especially depression (4, 8, 9). "
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    ABSTRACT: Background: Evidence indicates that early life stress (ELS) can induce persistent changes in the hypothalamic-pituitary-adrenal (HPA) axis to respond to stress in the adult life that leads to depression. These appear to be related to the impairment of HPA hormones through binding to glucocorticoid (GR) and mineralocorticoid receptors (MR). The aim of this study was to evaluate the impact of ELS in HPA axis response to challenges with GR and MR agonists in depressed patients. Methods: We included 30 subjects, 20 patients with current major depression (HAM-D21 ≥ 17). Patients were recruited into two groups according to ELS history assessed by the Childhood Trauma Questionnaire (CTQ). The cortisol measures in the saliva and plasma were evaluated after using (at 10:00 p.m.) placebo, fludrocortisone (MR agonist), or dexamethasone (GR agonist). Results: Depressed patients showed a significantly lower salivary cortisol upon waking after placebo compared with controls. Moreover, cortisol awakening responses (CAR) after MR agonist were found to be lower in depressed patients than in controls. With CTQ scores, HAM-D21, body mass index and CAR after placebo, GR agonist, MR agonist we found in a Linear Regression model that depressive patients with ELS (p = 0.028) show differences between placebo vs. MR agonist (R = 0.51; p < 0.05) but not after GR agonist; in depressive patients, without ELS the data show differences between placebo vs. MR agonist (R = 0.69; p < 0.05); but now as well placebo vs. GR agonist (R = 0.53; p < 0.05). Conclusion: Our findings indicate that MR activity is impaired in depressed patients compared with controls. Furthermore, in spite of the previous limitations described, in depressed patients with ELS, there was suppression by MR agonist, indicating that patients with ELS are sensitive to MR agonists. In contrast with depressed patients without ELS, we find suppression after both MR and GR agonist. These data suggested that in ELS an imbalance exists between MR and GR with MR dysfunction.
    Frontiers in Psychiatry 01/2014; 5:2. DOI:10.3389/fpsyt.2014.00002
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    • "Although a history of adverse childhood experience predicts more severe psychopathology, IPT can be a helpful approach for depressed patients with comorbid post-traumatic stress disorder (PTSD) or trauma history (Talbot et al., 2011; Green, Krupnick, & Chung, 2006). In another study, in which depressed persons were treated with IPT or pharmacotherapy, which were subsequently combined if monotherapy was insufficient, those with a history of childhood abuse did better with combined IPT and pharmacotherapy treatment than with high attachment avoidance (Miniati et al., 2010). In studying IPT for traumatic grief, after the loss of a significant other from an unexpected and violent cause, researchers found in this highly selected patient population that IPT did poorly compared with a specialized grief treatment that incorporated imaginal exposure (Shear, Frank, Houck, & Reynolds, 2005). "
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    ABSTRACT: Interpersonal psychotherapy (IPT) is an effective treatment for depression across the lifespan and across cultures. However, even when delivered with fidelity, some patients drop out and others do not improve sufficiently. Attention to IPT treatment attrition, dropout, nonresponse, or failure can elucidate its limitations and the opportunities to improve its effectiveness. Studies of factors known to moderate and negatively predict IPT depression treatment response are reviewed along with recommended modifications to improve outcomes. Although the risk of treatment failure always exists, it is possible to enhance treatment effectiveness by attending to the therapeutic alliance, strategically addressing depression, and adapting IPT to patient characteristics. These include adding pharmacotherapy, extending the course of treatment, and targeting specific symptoms or interpersonal vulnerabilities. Case examples illustrate several of these points.
    Journal of Clinical Psychology 11/2011; 67(11):1129-39. DOI:10.1002/jclp.20850 · 2.12 Impact Factor
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