The most commonly used methods to treat major depressive disorder (MDD) are interpersonal psychotherapy (IPT), cognitive behavioral therapy (CBT), and antidepressants (ADM). Many people who seek treatment for MDD respond well to one or a combination of these types of treatments. But many who try them do not. For these individuals, the chance of relapse, recurrence, and further stress is significantly high. Being able to address the factors that prevent people from responding to treatment can help clinicians focus on finding treatments that work best for these unique individuals.
Childhood maltreatment is a significant life event that can severely traumatize an individual and lead to serious mental health problems, including MDD. Previous research has shown that individuals with a history of childhood abuse engage in avoidant behaviors that can prevent them from interacting with others and are at heightened risk for relapse and recurrence of depression. To determine which approach would best help these people recover from their depression, Kate L. Harkness of the Department of Psychology at Queen’s University in Ontario, Canada, led a study evaluating the outcomes of 203 participants with MDD with a history of extreme childhood trauma or abuse.
Harkness evaluated the participants as they went through 16 weeks of IPT, CBT, or ADM. They were assessed for childhood abuse, including emotional, sexual, and physical abuse and a follow-up was completed at 12 months. The results revealed that the participants with no history of abuse responded equally well to all forms of treatment. However, those with the most severe forms of childhood maltreatment responded the best to ADM, followed closely by CBT. Harkness believes there could be multiple explanations for these findings. First, these participants may need more than just 4 months of treatment to see improvements. Second, the avoidant behaviors used by these participants may prevent them from fully engaging with the therapist during IPT, thus compromising the therapeutic alliance, a key component of treatment success. Additionally, the most severely maltreated participants were also the most likely to suffer depression relapses, regardless of gains made in treatment. Harkness added, “These results suggest that proper assignment of patients to treatment and rigorous follow-up of these patients at greatest risk for recurrence has the potential to prevent a life-long pattern of illness.”
Reference:
Harkness, K. L., Bagby, R. M., Kennedy, S. H. (2012). Childhood maltreatment and differential treatment response and recurrence in adult major depressive disorder. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0027665
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