Childhood maltreatment history for guiding personalized antidepressant choice in major depressive disorder: Preliminary results from a systematic review

Childhood maltreatment (CM) is a predictor of poor outcome across treatments for major depressive disorder (MDD), while its potential role as a predictor of differential responses to specific antidepressants has received little attention. The present systematic review examined pharmacological studies (published up to June 30th, 2020) that included head-to-head comparisons of antidepressant treatments among adult MDD patients with a reported history of CM or no history to evaluate if CM may help clinicians choose antidepressants with greatest likelihood of successful outcome. Only three studies were included, providing limited and provisional results. These preliminary findings suggest that sustained-release bupmpion (alone or in combination) or aripiprazole-augmentation as next-step intervention did not demonstrate differential outcome among MDD patients with or without a history of childhood adversity. Further, sertraline and the group of antidepressants with low affinity for the semtonin transporter may be less suitable for MDD patients with childhood abuse history than escitalopram, venlafaxine-XR, or antidepressants with high affinity for the serotonin transporter. The critical question of the most potentially efficacious treatment regimens for adult MDD with CM history requires further large-sample studies involving a greater number of medications, specifically designed to analyse the moderating effects of different types of CM, and possibly including objective biomarkers.

Automated summary

This systematic review examined pharmacological studies comparing antidepressant treatments among MDD patients with or without a history of childhood maltreatment. Preliminary findings suggest that childhood maltreatment history may influence the choice of antidepressants for successful outcomes, but further large-sample studies are needed to confirm these results.