Abstract
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.
Highlights
The adverse effects of childhood abuse on health are substantial and well-documented
Twenty years after the first study investigating the effects of ketamine/esketamine on depression and suicide, there is a lack of data on the child sexual abuse (CSA) effects on this emerging treatment
We assess the impact of CSA on adjunctive subcutaneous (SC) esketamine for treatment-resistant depression (TRD)
Summary
The adverse effects of childhood abuse on health are substantial and well-documented. Most studies solely include reports from children’s protection services, detecting only a small fraction of cases [4]. This type of trauma can be considered as “toxic” and causes a prolonged activation of the body’s stress response system [5]. 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. We assess the impact of CSA on adjunctive subcutaneous (SC) esketamine for treatment-resistant depression (TRD)
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