Impact of self-reported juvenile abuse on treatment outcome in patients with major depressive disorder

摘要

Background: We assessed the impact of juvenile abuse (emotional, physical, or sexual) on response to treatment in adults with major depressive disorder (MDD) suboptimally responsive to antidepressant therapy. Methods: A post hoc analysis explored the relationship between self-reported history of juvenile abuse and response to risperidone or placebo augmentation during a 6-week double-blind study period in patients with MDD suboptimally responsive to a previous adequate trial of antidepressant monotherapy. Results: Overall, only one clinical measure showed a small, but statistically significant difference in outcome between patients with abuse versus without abuse (1-IRSD-17). In patients reporting abuse (n = 141), improvement with risperidone versus placebo augmentation was greater on several measures: HRSD-17 total and 2 subscale scores, responder rates, Q-LES-Q and PaRTS-D. In patients without abuse (n=127), only two measures showed significant improvement: HRSD-17 subscale and PaRTS-D. Responder rates (HRSD-17) were: 409% (risperidone) versus 231% (placebo; p =001; odds ratio =27) in those with abuse, and 410% versus 34.4% (p=O.39 odds ratio=1A) in those without. Adverse events rates were: 370% (risperidone) and 54.4% (placebo) in patients with abuse, and 563% and 556% in those without. Limitations: Analysis not preplanned. Validated questionnaire not used to determine abuse status. Conclusions: Self-reported juvenile abuse history may impact response to risperidone augmentation therapy in adults with MDD suboptimally responsive to antidepressants. Abuse status may reduce placebo response and reporting of adverse events.