The Influence of Childhood Trauma on the Real-World Effectiveness of Ketamine in Adults With Treatment-Resistant Depression

IF 5.3 2区医学 Q1 PSYCHIATRY

Acta Psychiatrica Scandinavica Pub Date : 2025-04-16 DOI:10.1111/acps.13812

Danica E. Johnson, Nelson B. Rodrigues, Rodrigo B. Mansur, Roger S. McIntyre, Joshua D. Rosenblat

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Abstract

Introduction

Childhood trauma is a well-established risk factor for major depressive disorder (MDD) and is often associated with attenuated response to conventional antidepressant therapies. Ketamine has emerged as an effective treatment for treatment-resistant depression (TRD), but the impact of childhood trauma on its effectiveness remains unclear. Herein, we aimed to determine whether childhood trauma influences the antidepressant effectiveness of ketamine in TRD.

Methods

A retrospective analysis was performed on data from adults with TRD (n = 83) who received four ketamine infusions at a community outpatient clinic. Participants were categorized based on cumulative trauma load (high vs. low) and specific trauma types, assessed by the Childhood Trauma Questionnaire (CTQ). Depressive symptoms were measured using the Quick Inventory of Depressive Symptomatology Self-Report 16-item (QIDS-SR16) at baseline and following each infusion. Linear mixed models and chi-square tests were used to evaluate the impact of trauma on ketamine's antidepressant effectiveness.

Results

Depressive symptoms significantly decreased across all participants over time, with an average reduction of 5.7 points in QIDS-SR16 scores (p < 0.001). High childhood trauma load was reported by 55% of participants. Response rates were 25% in the high trauma load group and 19% in the low trauma load group, while remission rates were 14% and 11%, respectively. However, there were no significant differences in antidepressant effectiveness (p = 0.572), response rates (p = 0.230), or remission rates (p = 0.397) between participants with high versus low trauma loads. Further analysis also revealed no significant associations between specific types of childhood trauma and antidepressant effectiveness, response, or remission outcomes.

Conclusion

Childhood trauma did not attenuate ketamine's antidepressant effectiveness in TRD. These findings support ketamine as a viable treatment for individuals with TRD, including those with significant trauma histories. Further research is warranted to replicate these findings and explore underlying mechanisms.

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童年创伤对成人难治性抑郁症氯胺酮实际疗效的影响

童年创伤是重度抑郁障碍（MDD）的一个公认的危险因素，通常与传统抗抑郁治疗的反应减弱有关。氯胺酮已成为治疗难治性抑郁症（TRD）的有效方法，但儿童创伤对其有效性的影响尚不清楚。在此，我们旨在确定童年创伤是否会影响氯胺酮在TRD中的抗抑郁效果。方法回顾性分析83例在社区门诊接受4次氯胺酮输注的TRD患者的资料。参与者根据累积创伤负荷（高与低）和特定创伤类型进行分类，并通过儿童创伤问卷（CTQ）进行评估。在基线和每次输注后使用抑郁症状自我报告快速量表16项（QIDS-SR16）测量抑郁症状。采用线性混合模型和卡方检验评价创伤对氯胺酮抗抑郁疗效的影响。结果：随着时间的推移，所有参与者的抑郁症状显著减轻，QIDS-SR16评分平均降低5.7分（p < 0.001）。55%的参与者报告了高童年创伤负荷。高创伤负荷组的缓解率为25%，低创伤负荷组的缓解率为19%，缓解率分别为14%和11%。然而，在高创伤负荷和低创伤负荷的参与者之间，抗抑郁药物的有效性（p = 0.572）、反应率（p = 0.230）或缓解率（p = 0.397）没有显著差异。进一步的分析还显示，特定类型的儿童创伤与抗抑郁药的疗效、反应或缓解结果之间没有显著的关联。结论童年创伤并未减弱氯胺酮对TRD患者的抗抑郁作用。这些发现支持氯胺酮作为治疗TRD患者的可行方法，包括那些有严重创伤史的患者。需要进一步的研究来重复这些发现并探索潜在的机制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Psychiatrica Scandinavica 医学-精神病学

CiteScore

11.20

自引率

3.00%

发文量

135

审稿时长

6-12 weeks

期刊介绍： Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.