Summary: Patients with major depressive disorder who experienced trauma during childhood see symptom improvement following psychopharmacological intervention, psychotherapy, or a combination of both.

Adults with major depressive disorder who have a history of childhood trauma experience symptom improvement after pharmacotherapy, psychotherapy, or combination treatment.

The results of a new study, published in The Lancet Psychiatry, suggest that contrary to current theory, these common treatments for major depressive disorder are effective for patients with childhood trauma.

It is therefore important to determine whether current treatments offered for major depressive disorder are effective for patients with childhood trauma,” says Ph.D.

Although childhood trauma patients reported more depressive symptoms at both the start and end of the treatment, they experienced similar symptom improvement compared to patients without childhood trauma history.

The measured treatment efficacy did not vary by childhood trauma type, depression diagnosis, assessment method of childhood trauma, study quality, year, treatment type or length.

The meta-analysis focused on symptom decline during acute treatment phase, but people with depression and childhood trauma often show post-treatment residual symptoms and are characterized by a high risk of relapse, thus they may benefit from treatment significantly less than patients without childhood trauma in the long run.

“Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis” by Erika Kuzminskaite et al.

Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis.

Some studies indicate that evidence-based pharmacotherapies and psychotherapies for adult depression might be less efficacious in patients with a history of childhood trauma than patients without childhood trauma, but findings are inconsistent.

Therefore, we examined whether individuals with major depressive disorder, including chronic forms of depression, and a reported history of childhood trauma, had more severe depressive symptoms before treatment, had more unfavourable treatment outcomes following active treatments, and were less likely to benefit from active treatments relative to a control condition, compared with individuals with depression without childhood trauma.

More than half (4268 [62%] of 6830) of patients with major depressive disorder reported a history of childhood trauma

Despite having more severe depression at baseline (g=0·202, 95% CI 0·145 to 0·258, I2=0%), patients with childhood trauma benefitted from active treatment similarly to patients without childhood trauma history (treatment effect difference between groups g=0·016, –0·094 to 0·125, I2=44·3%), with no significant difference in active treatment effects (vs control condition) between individuals with and without childhood trauma (childhood trauma g=0·605, 0·294 to 0·916, I2=58·0%; no childhood trauma g=0·178, –0·195 to 0·552, I2=67·5%; between-group difference p=0·051), and similar dropout rates (risk ratio 1·063, 0·945 to 1·195, I2=0%)

Findings did not significantly differ by childhood trauma type, study design, depression diagnosis, assessment method of childhood trauma, study quality, year, or treatment type or length, but differed by country (North American studies showed larger treatment effects for patients with childhood trauma; false discovery rate corrected p=0·0080)

Contrary to previous studies, we found evidence that the symptoms of patients with major depressive disorder and childhood trauma significantly improve after pharmacological and psychotherapeutic treatments, notwithstanding their higher severity of depressive symptoms

Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder regardless of childhood trauma status