Saint Louis University, St. Louis, MO, USA
Background: Major depressive disorder (MDD) affects more than 16.1 million American adults each year. Adverse childhood experiences (ACES) include an array of early life experiences from child abuse and neglect to loss of an attachment figure. While many individuals report success and symptom reduction with antidepressant therapy, a large portion of individuals with depression don’t respond to antidepressants. The etiology of depression for many individuals may be attributed to ACES, potentially resulting in different therapeutic responses. This systematic review investigated the direct relationship between ACEs and antidepressant medications (ADM). The review focused on prevalence, etiology, and treatment efficacy. Methods: A combined searches was used containing the two terms, ACES and antidepressants, using PubMed and PsycINFO. All searches yielded 2219 articles that after duplicate removal included 1780 articles reviewed for potential inclusion. Inclusion criteria included conjointly examining ACEs and ADM for depression in humans and exclusion criteria included bipolar and psychosis comorbidities. A total 20 articles met study criteria. Results: Combined samples (N=517,256) across articles were divided into five unique themes of epigenetics and ADM efficacy (n = 673), ADM efficacy (n = 5244), ADM compared to or combined with psychotherapy (n=587), suicide risk (n=970), and prevalence data (n=509,782). Findings suggest that ACES is associated with a greater likelihood of using ADMs and an interaction between DNA methylation and ADM efficacy. ACEs was also linked to a suicide risk when using ADM. Conclusions: With a better understanding of how ACES impact the etiology of depression, physicians can better monitor patients with a history of ACEs as findings imply a developmental risk factor that may make individuals increasingly vulnerable to depression with an unfavorable course (e.g., suicide risk, symptom severity, recurrent depression).