A Clinical Rationale for Assessing the Impact of Childhood Sexual Abuse on Adjunctive Subcutaneous Esketamine for Treatment-Resistant Depression

Frontiers in Psychiatry

Acioly Luiz Tavares Lacerda¹  Hugo Cogo-Moreira²  Charles B. Nemeroff³  Lorena Catarina Del Sant⁴  Ana Cecília Lucchese⁴  Marco Aurélio Tuena⁴  Guilherme Abdo⁴  Carolina Nakahira⁴  Camila Brito Puertas⁴  Luciana Maria Sarin⁴  Victor Augusto Rodovalho Fava⁴  Matheus Ghossain Barbosa⁴  Eduardo Jorge Muniz Magalhães⁴  Juliana Surjan⁶  José Alberto Del Porto⁶  Rodrigo Simonini Delfino⁶  Matheus Souza Steglich⁶  Andrea Feijo Mello⁷ 

[1] CNS Unit, BR Trials, São Paulo, Brazil;Department of Education, ICT and Learning, Faculty of Teacher Education and Languages, Østfold University College, Halden, Norway;Department of Psychiatry and Behavioral Sciences, Institute of Early Life Adversity Research, Dell Medical School, University of Texas at Austin, Austin, TX, United States;Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil;Laboratory of Integrative Neuroscience, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil;Program for Care on Affective Disorders, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil;Program for Research and Care on Violence and Post-traumatic Stress Disorder, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil;

关键词: child sex abuse;    treatment-resistant depression;    esketamine;    sex;    directed acyclic graph;   

DOI  :  10.3389/fpsyt.2021.608499

来源: DOAJ

【 摘 要 】

Background: A history of child sexual abuse (CSA) is related to higher suicide rates and poor treatment outcomes in depressed adult patients. Twenty years after the first study investigating the effects of ketamine/esketamine on depression and suicide, there is a lack of data on the CSA effects on this emerging treatment. Here, we assess the impact of CSA on adjunctive subcutaneous (SC) esketamine for treatment-resistant depression (TRD).Methods: A directed acyclic graphic (DAG) was designed to identify clinical confounders between CSA and esketamine predictors of response. The confounders were applied in a statistical model to predict depression symptom trajectory in a sample of 67 TRD outpatients.Results: The patient sample had a relatively high prevalence rate of CSA (35.82%). Positive family history of first-degree relatives with alcohol use disorder and sex were clinical mediators of the effects of esketamine in a CSA adult population. Overall, the presence of at least one CSA event was unrelated to esketamine symptom reduction.Conclusions: Unlike responses to conventional antidepressants and psychotherapy, CSA does not appear to predict poor response to esketamine.

【 授权许可】

Unknown