TY  - JOUR
PY  - 2009//
TI  - Early adversity in chronic depression: clinical correlates and response to pharmacotherapy
JO  - Depression and anxiety
A1  - Klein, Daniel N.
A1  - Arnow, Bruce A.
A1  - Barkin, Jennifer L.
A1  - Dowling, Frank
A1  - Kocsis, James H.
A1  - Leon, Andrew C.
A1  - Manber, Rachel
A1  - Rothbaum, Barbara Olasov
A1  - Trivedi, Madhukar H.
A1  - Wisniewski, Stephen R.
SP  - 701
EP  - 710
VL  - 26
IS  - 8
N2  - BACKGROUND: There is growing evidence suggesting that early adversity may be a marker for a distinct pathway to major depressive disorder (MDD). We examined associations between childhood adversity and a broad variety of clinical characteristics and response to pharmacotherapy in a large sample of patients with chronic forms of MDD. METHODS: Subjects included 808 patients with chronic forms of MDD (chronic MDD, double depression, or recurrent MDD with incomplete recovery between episodes and a total continuous duration of >2 years) who were enrolled in a 12-week open-label trial of algorithm-guided pharmacotherapy. Baseline assessments included a semi-structured diagnostic interview, and clinician- and self-rated measures of depressive symptoms, social functioning, depressotypic cognitions, and personality traits, and childhood adversity. Patients were re-evaluated every 2 weeks. RESULTS: A longer duration of illness; earlier onset; greater number of episodes, symptom severity, self-rated functional impairment, suicidality, and comorbid anxiety disorder; and higher levels of dysfunctional attitudes and self-criticism were each associated with multiple forms of childhood adversity. A history of maternal overcontrol, paternal abuse, paternal indifference, sexual abuse, and an index of clinically significant abuse each predicted a lower probability of remission. Among patients completing the 12-week trial, 32% with a history of clinically significant abuse, compared to 44% without such a history, achieved remission. CONCLUSIONS: These findings indicate that a history of childhood adversity is associated with an especially chronic form of MDD that is less responsive to antidepressant pharmacotherapy.<p /> <p>Language: en</p>
LA  - en
SN  - 1091-4269
UR  - http://dx.doi.org/10.1002/da.20577
ID  - ref1
ER  -