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Magalhães EJM, Sarin LM, Del Sant LC, Lucchese AC, Nakahira C, Tuena MA, Puertas CB, Rodovalho Fava VA, Delfino RS, Surjan J, Steglich MS, Barbosa MG, Abdo G, Del Porto JA, Nemeroff CB, Cogo-Moreira H, Lacerda ALT, Mello AF. A Clinical Rationale for Assessing the Impact of Childhood Sexual Abuse on Adjunctive Subcutaneous Esketamine for Treatment-Resistant Depression. Front Psychiatry 2021; 12:608499. [PMID: 34483976 PMCID: PMC8415867 DOI: 10.3389/fpsyt.2021.608499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 07/12/2021] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
| | - Luciana Maria Sarin
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Carolina Nakahira
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Marco Aurélio Tuena
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Rodrigo Simonini Delfino
- 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
| | - Juliana Surjan
- 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
| | - Matheus Souza Steglich
- 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
| | | | - Guilherme Abdo
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - José Alberto Del Porto
- 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
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, Institute of Early Life Adversity Research, Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Hugo Cogo-Moreira
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,Department of Education, ICT and Learning, Faculty of Teacher Education and Languages, Østfold University College, Halden, Norway
| | - Acioly Luiz Tavares Lacerda
- 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.,Laboratory of Integrative Neuroscience, Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.,CNS Unit, BR Trials, São Paulo, Brazil
| | - Andrea Feijo Mello
- 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
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