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Early Life Adversity as a Moderator of Symptom Change following Selective Serotonin Reuptake Inhibitors and Cognitive Behavioral Therapy

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Abstract

Background

Early Life Adversity (ELA) is consistently linked to chronic, treatment-resistant depression and anxiety. Selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) represent the two first-line treatments for internalizing disorders. However, little is known about the efficacy of these therapies for individuals with ELA, particularly within heterogeneous cohorts of patients with high levels of comorbidity.

Methods

Treatment seeking adults with depression and/or anxiety were randomized to twelve weeks of SSRI (n = 46) or CBT (n = 50), and internalizing disorder symptoms were assessed pre- and post-treatment. Individuals with and without ELA were included.

Results

Both SSRI and CBT resulted in reductions in internalizing symptoms, as expected. A significant ELA by treatment type interaction for depression, but not anxiety, also emerged. Individuals with a positive history of ELA had a greater reduction in depression symptoms following SSRIs compared with CBT. In contrast, individuals with a negative history of ELA had a greater reduction in depression symptoms following CBT compared with SSRIs.

Conclusions

Findings suggest that SSRIs may be particularly effective for individuals with ELA and CBT may be particularly effective for individuals without ELA in reducing depression, but not anxiety, symptoms. Clinical implications and future directions are discussed.

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Notes

  1. Exploratory post-hoc analyses were conducted to assess whether effects are sustained when examining emotion-based ELA only (i.e., emotional abuse, emotional neglect). The same pattern of significance is retained in post-hoc analyses. Regression tables can be found in Supplementary Materials online at [link].

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Funding

This study was funded by the National Institute of Mental Health of the National Institutes of Health Grant R01MH101497 (to KLP) and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR002003 and Center for Clinical and Translational Science (CCTS) UL1RR029879. KLB is supported by National Institute of Mental Health Grant K23-MH113793-01. SMG is supported by National Institute of Alcohol Abuse and Alcoholism Grant K23-AA025111.

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The sponsors had no role in the design, analysis, interpretation, or publication of this study.

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Authors and Affiliations

  1. Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA

    Meredith A. Gruhn, Heide Klumpp & Olusola Ajilore

  2. Department of Psychiatry and Behavioral Health, Institute for Behavioral Medicine Research, Ohio State University, Columbus, OH, USA

    K. Luan Phan & Stephanie M. Gorka

  3. Institute for Juvenile Research #235, 1737 W. Roosevelt Road, Chicago, IL, 60612, USA

    Meredith A. Gruhn

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Correspondence to Meredith A. Gruhn.

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Meredith A. Gruhn, K. Luan Phan, Heide Klumpp, Olusola Ajilore, and Stephanie M. Gorka declare that they have no conflict of interest.

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Gruhn, M.A., Phan, K.L., Klumpp, H. et al. Early Life Adversity as a Moderator of Symptom Change following Selective Serotonin Reuptake Inhibitors and Cognitive Behavioral Therapy. Cogn Ther Res 45, 343–354 (2021). https://doi.org/10.1007/s10608-020-10158-5

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