Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Psychology School, Fresenius University of Applied Sciences Berlin, Berlin, Germany.
Clin Psychol Psychother. 2017 Sep;24(5):1155-1162. doi: 10.1002/cpp.2081. Epub 2017 Mar 21.
Childhood maltreatment (CM) has been indicated as a predictor of a differential response to antidepressant treatment with psychotherapy compared to medication. In this secondary analysis, we investigated whether the presence of CM results in a differential indication for the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or escitalopram plus clinical management (ESC). Sixty patients with chronic depression were randomized to either 22 sessions of CBASP or ESC over the course of 8 weeks of acute and 20 weeks of extended treatment at 2 German treatment sites. CM was assessed using the Childhood Trauma Questionnaire and the clinician rated Early Trauma Inventory. Intention-to-treat analyses were used to examine the impact of CM on depression, global functioning, and quality of life. The presence of CM did not result in significant differences in treatment response to CBASP or ESC on any outcome measure after 28 weeks of treatment independent of the type of CM assessment. After 8 weeks, a significant CM × treatment interaction was found for scores on the Montgomery-Asberg Depression Rating Scale. Patients with a history of CM receiving CBASP had a significantly lower response rate compared to patients without CM and to those receiving ESC after 8 weeks. Conclusively, CBASP and ESC are equally effective treatment options for the difficult to treat subgroup of patients with chronic depression and a history of CM. CM may be a predictor of a longer latency of treatment response in the case of psychotherapy.
CBASP and escitalopram are equally effective treatment options for chronic depression. Both treatments are also equally effective for the difficult to treat subgroup of patients with chronic depression and a history of childhood maltreatment. Childhood maltreatment may result in a longer latency of treatment response in the case of psychotherapy.
童年期虐待（CM）已被证明是预测抗抑郁药物治疗与心理治疗相比对药物治疗反应差异的指标。在这项二次分析中，我们调查了 CM 的存在是否导致认知行为分析系统心理治疗（CBASP）或依西酞普兰加临床管理（ESC）的不同指示。60 名慢性抑郁症患者被随机分配到 22 节 CBASP 或 ESC 课程中，为期 8 周的急性治疗和 20 周的延长治疗，在德国的 2 个治疗点进行。CM 使用童年创伤问卷和临床医生评定早期创伤量表进行评估。意向治疗分析用于检查 CM 对抑郁、整体功能和生活质量的影响。在 28 周的治疗后，CM 对 CBASP 或 ESC 治疗反应的任何结果测量都没有显著差异，无论使用哪种 CM 评估。在 8 周后，在蒙哥马利-阿斯伯格抑郁评定量表上的分数发现了 CM×治疗的显著交互作用。接受 CBASP 的有 CM 病史的患者与无 CM 病史的患者和接受 ESC 的患者相比，8 周后的反应率显著降低。总之，CBASP 和 ESC 对慢性抑郁症和有 CM 病史的患者这一难以治疗的亚组是同样有效的治疗选择。CM 可能是心理治疗中治疗反应潜伏期较长的预测指标。
关键从业者信息：CBASP 和依西酞普兰是慢性抑郁症的有效治疗选择。对于慢性抑郁症和有童年期虐待史的难以治疗的患者亚组，两种治疗方法同样有效。童年期虐待可能导致心理治疗中治疗反应潜伏期延长。
