Having experienced traumatic events is one of the main factors associated with the development of psychiatric disordersespecially, depression. The impact of childhood trauma on this psychiatric illness so prevalent has been one of the main topics addressed at the Conference on Affective Disorders, recently organized by Lundbeckin which William Lahera, full professor of Psychiatry at the University of Alcalá, linked to the Príncipe de Asturias University Hospital, and CIBERSAM researcher, has highlighted this association. In addition, the meeting has also focused on the seriousness of dual depression -major depressive disorder comorbid with a substance use disorder-, in charge of Lara Graucoordinator of the Addictions and Dual Pathology Section of the Psychiatry Service of the Vall d’Hebron University Hospital.
The impact of childhood trauma on depression
Traumatic experiences are those that endanger the life of the person or their physical and mental integrity. They are experienced with intense fear, terror or feelings of helplessness. Having gone through these experiences has a very marked impact on the development of depression in adult lifeas Lahera highlighted during his speech.
And it is that, as he explained, trauma has a direct neurobiological effect, for example, shortening the length of telomeres, the final part of chromosomes. There is also an association between trauma and inflammatory markers, from proinflammatory cytokines to decreased BDNF. Patients with a history of traumatic experiences have, for example, higher blood pressure levels or metabolic syndrome.
As this expert concludes, trauma directly affects the part of the brain and the body that is related to mood regulation and markedly increases the incidence of depression.
But the relationship between trauma and depression can be analyzed from two directions, Lahera explained. On the one hand, patients diagnosed with depression have a greater sequence of traumatic experiences than those who do not have depression, specifically, Around 62% of patients with depression have had two or more traumatic experiences, compared to 28% in the control population. On the other hand, patients who have lived through traumatic experiences have a higher rate of depression than those who have not. Throughout life, it is estimated that around 60% of men and 50% of women will experience some traumatic experience.
In addition, trauma influences the prognosis of depression. Having had a history of childhood trauma increases the frequency of occurrence of depression. Depression starts earlier, there are worse response and remission rates. Several neurobiological mediators of this resistance to treatment have been hypothesized, but an association has even been seen between trauma and structural alterations in some areas such as the insula, the prefrontal cortex, and also with inflammatory markers. Trauma is associated with a higher risk of suicide, a higher rate of substance use and greater metabolic alterations. It is, therefore, a really important factor in the assessment of depressive patients, Lahera recalled.
Diagnosis and differential approach to trauma in depression
Integrating trauma into the assessment of the depressed patient is important. Sometimes doctors have underestimated this risk factor that is so relevant in the biography of patients, this CIBERSAM researcher has acknowledged. For this reason, he advocates identifying that subgroup of depressive patients in whom a worse response to treatment can be expected in order to provide them with the highest quality and most specialized care possible, what the authors call “sensitive care”. trauma”.
Regarding treatment, psychotherapy appears as the modality of choice through cognitive behavioral therapy, progressive exposure and, in some cases, EMDR -awareness through eye movements-. “Within antidepressants, studies on efficacy in this traumatized subpopulation are lacking. Among those studied, vortioxetine stands out, which has, according to a recent meta-analysis, four short-term studies and a relapse prevention study in which it has shown superiority to placebo”, Lahera has revealed.
Dual depression, a more serious clinical entity
Among the clinical characteristics of a depressive disorder comorbid to a substance use disorder or any other addiction, is its greatest severity compared to the existence of a single pathology. These patients have more depressive symptomatology, more psychotic symptoms associated with consumption or outside of consumption, more heteroaggressive and self-injurious ideas and, therefore, suicidal ideas and self-harm gestures are more frequent and, in general, they use more therapeutic resources than those who They have a single pathology. They also present greater comorbidity with other medical illnesses and, in this way, the treatment has to be very intensive, explained Lara Grau.
The first therapeutic objective is through achieve good follow-up and good adherence to treatment, given the greater difficulty for these patients to attend a consultation and ask for help. In addition to follow-up and good bonding, the objective would be to achieve a remission of the depressive symptoms together with abstinence from substance use or addiction. This is the objective to improve the quality of life and its global functioning, this specialist has detailed.
Refering to efficacy of treatments in dual depression, The specialist has referred to the existence of various clinical trials with different drugs currently prescribed, which describe that SSRI-type antidepressants, the most widely used in clinical practice, have not shown efficacy in dual depression. Some trials have found that antidepressants such as the tricyclic imipramine may be effective in depression with alcohol use disorder, but not with other substance use disorder. In general, what the studies summarize is that antidepressants work well for clinical depression, but not for addiction remission, has explained. Therefore, new antidepressant treatments have to be used to assess whether they have any efficacy in substance use or if they improve other symptoms of dual depression, but more studies are still needed to determine this efficacy.
Lara Grau has also referred to the use of vortioxetine in dual depression as “a good option”, because other antidepressants have not shown efficacy in dual depression. Also, “vortioxetine it has an action profile that not only improves depressive symptoms, but also cognitive symptoms. Addicted patients have many cognitive deficits because substance use causes progressive cognitive decline, and we are currently trying to address this, so I think vortioxetine would be a good drug to be able to help non-dual depression patients. not only to improve the depressive symptoms and assess whether substance use improves, but also to improve these cognitive alterations that they may have and are so important to maintain long-term abstinence”.
Although it may contain statements, data or notes from health institutions or professionals, the information contained in Medical Writing is edited and prepared by journalists. We recommend the reader that any questions related to health be consulted with a health professional.
