What are the implications of childhood trauma for depression and its response to therapy?

Many people with MDD have experienced childhood trauma

Associated with a more chronic course of MDD

The many types of childhood trauma (or adverse childhood experience [ACE]) include emotional, sexual and physical interpersonal abuse; family separation, breakup or conflict; and experiences of natural disaster.^1,2

Among 1008 participants in the international Study to Predict Optimized Treatment for Depression (iSPOT-D), 62.5% reported at least two childhood traumatic events compared with 28.4% of 336 healthy controls (p<0.01).¹

Negative effects on mental, psychosocial and physical health

An adverse effect on cognitive and brain development

Childhood trauma has a detrimental effect on cognitive development associated with lower IQ, complex visual attention, verbal memory, learning, planning, problem solving, processing speed, language, reading and mathematics scores.³

Having had at least one ACE is significantly associated (p<0.0001) with risk-taking behaviors in adolescents (cigarette smoking, alcohol use, street drug use, at least one suicide attempt) compared with individuals with no ACE.²

More ACEs are also associated with a higher rate of serious family, job and financial problems, and a higher rate of stress, substance abuse and MDD in adult life.^2,4

Adverse effects on physical health include a shorter telomere length in children at 5 and 10 years of age,⁵ general low-grade inflammation in adulthood with higher levels of inflammatory biomarkers,⁶ a higher blood pressure⁷ and a higher prevalence of obesity.⁷

A poor response to standard antidepressants

Less likely to respond to SSRI or SNRI

The more chronic course of MDD experienced by people with a history of childhood trauma is compounded by its poor response to standard antidepressant therapy.¹

Patients with MDD experiencing childhood trauma between 4 and 7 years of age are 1.6 times less likely to achieve response or remission at 8 weeks when treated with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs).¹ Among 722 participants in iSPOT-D:

• the response rate was only 17.7% compared with 82.3% for patients with no history of childhood abuse
• the remission rate was only 15.9% compared with 84.1% for patients with no history of childhood abuse¹