Logo image
Back
A history of early life parental loss or separation is associated with successful cognitive-behavioral therapy in major depressive disorder
Journal article   Open access   Peer reviewed

A history of early life parental loss or separation is associated with successful cognitive-behavioral therapy in major depressive disorder

Mark J Niciu, Chadi G Abdallah, Lisa R Fenton, Madonna K Fasula, Anne Black, George M Anderson and Gerard Sanacora
Journal of affective disorders, Vol.187, pp.241-244
11/15/2015
DOI: 10.1016/j.jad.2015.08.026
PMCID: PMC4814568
PMID: 26363143
url
http://doi.org/10.1016/j.jad.2015.08.026View
Open Access

Abstract

There is a clinical need for evidence-based psychotherapy response biomarkers in major depressive disorder (MDD). Based on previous studies, we hypothesized that lower 24-h urinary cortisol levels and a history of early life stress/trauma would predict an improved antidepressant response to cognitive-behavioral therapy (CBT). 50 currently depressed MDD subjects were enrolled. 24-h urine was collected and measured for cortisol levels by radioimmunoassay (RIA). Subjects were also administered early life stress/trauma measures at baseline: Global Perceived Early-Life Stress (GPELS), The Early Life Trauma Inventory (ELTI) and Klein Loss Scale (KLS). The efficacy of a twelve-week course of once-weekly CBT was evaluated by the primary outcome measure, the 24-item Hamilton Depression Rating Scale (HDRS24), at baseline and every four weeks, and the Beck Depression Inventory at baseline and weekly thereafter. 42 subjects had at least one complete follow-up visit (≥4 weeks of CBT), and 30 subjects completed the full 12-week course. Baseline 24-h urinary cortisol levels did not correlate with CBT’s antidepressant response. Higher KLS scores, a measure of early life parental loss or separation, correlated with delta HDRS24 (rs=−0.39, padjusted=0.05). Complementary general linear model analysis revealed enhanced CBT efficacy in patients with a history of early life parental loss or separation [F(1,35)=6.65, p=0.01]. Small sample size, Treatment-naïve population. Early life parental separation or loss positively correlated with CBT’s antidepressant efficacy in our sample and may warrant further study in larger clinical samples. •Preliminary studies suggest that early life stress/trauma and excessive hypothalamic-pituitary-adrenal axis activity correlates with antidepressant response to cognitive-behavioral therapy (CBT) in major depressive disorder.•Stress-related measures were correlated with antidepressant response to a 12-week course of once-weekly CBT in 50 currently depressed MDD outpatients.•As a measure of baseline hypothalamic-pituitary-adrenal axis activity, 24-hour urinary cortisol levels did not correlate with CBT’s antidepressant efficacy.•A personal history of early life parental loss or separation survived correction for multiple comparisons as a positive predictor of CBT response.•Other forms of early life stress/trauma and perceived early life stress did not correlate with CBT’s antidepressant efficacy.
 Hypothalamic-pituitary-adrenal axis Cortisol Cognitive-behavioral therapy Major depressive disorder Parental loss Parental separation

Details

Metrics

35 Record Views
9 Times Cited - Web of Science
Logo image