Is childhood abuse behind tough-to-treat depression?

(CBS) Why do some depressed people never seem to get better? A provocative new study suggests it may come down to the amount of mistreatment they experienced as kids.

A new study suggests adults who were abused as children are twice as likely to develop lasting bouts of depression as their counterparts who did not experience childhood mistreatment. And scientists say that can seriously impact their treatment and recovery.

For the study - published in the August 14 issue of the American Journal of Psychiatry - researchers reviewed 26 studies on 23,000 people where they saw the increased likelihood of recurrent depression among adults who were abused as kids. The researchers say previous studies show mistreated children and adults have more "biological abnormalities" in the brain, endocrine and immune system, which could alter treatment.

"Childhood maltreatment is associated both with an increased risk of developing recurrent and persistent episodes of depression, and with an increased risk of responding poorly to treatment," study author Dr. Andrea Danese, professor of child and adolescent psychiatry at King's College London, said in a written statement. The researchers found antidepressant medication, psychological treatment, or combinations of the two were less effective in those who suffered childhood abuse.

Danese told Reuters that knowing a formerly abused patient won't respond to treatment may "be valuable for clinicians in determining patients' prognosis."

What treatments would work then? The authors themselves aren't sure. Study co-author Dr. Rudolf Uher, a professor of psychiatry at Kings College told Reuters treatments may focus on the "biological vulnerabilities associated with childhood maltreatment." The hope is future treatments would be given preventively at an earlier age to be more effective long term.

An estimated one in 10 American adults are depressed, but the disease goes beyond feeling down in the dumps. It can adversely affect other conditions such as arthritis, asthma, cancer, diabetes, heart disease, and obesity. The World Health Organization estimates that by 2020, depression will be the second-leading contributor to the world's global disease burden.

Danese said in a written statement, "Identifying those at risk of multiple and long-lasting depressive episodes is crucial from a public health perspective."

Establishing Goals for Substance Abuse Treatment

Individuals who verbalize a commitment to abstaining from substance use or who enter therapy for drugs or alcohol, may not always be committed to the same goals for therapy as significant others who want him\her in treatment. I have worked in the chemical dependency field for over 25 years and believe it is important to understand someone’s motivation level when addressing this issue. A person may believe they could control or manage their drinking. Family members/significant others could be under the impression that goal is not realistic. Or a person may not believe their use is a problem and are entering treatment to appease others. This presents a conflict in treatment goals between client (person entering treatment) and others.

A therapist’s role is to help the client clarify goals in treatment. It is important to have mutually understood goals. If, as a therapist, I am presenting tools more consistent with someone who has a goal of complete abstinence, and this individual is not committed to stopping use all together, therapy will not be successful. The first step in the therapeutic process is endeavoring to be on the same page with the client. A helpful tool I use is the motivational wheel.

Once goals are established, we come up with tasks that will help meet these goals. If a person uses substances when his/her goals are abstinence we go over the motivational wheel again. We establish if the use was: a lapse (goal was abstinence but had a slip) or decision to use (goal was not to stop and decided to use). If it is determined to be a lapse, we examine goals and determine what areas may need further focus. Lapses are not uncommon in recovery and may actually help develop focus and commitment to stopping use. If the client made a decision to use, I will explore what may have changed from the initially stated goals.

Recovery is not a event, but a journey. Each person may carve their own individual
path. It may entail some slips or challenges along the way. For some it may take longer to reach this goal than others. What is essential in therapy is that goals in treatment are agreed upon, realistic, clear, and obtainable. If a person is not committed to stopping all together, my role will be to establish safe guidelines in exploring the costs to use and impact on one’s life.

How do you know if your teenager needs to see a therapist?

Teenagers are not always able to articulate what they are feeling. At this age they are going through many changes, which include hormonal, psychological, physical, and social. It is common that we may see a child struggle at some point during these years. Complicating matters, teenagers may not verbalize these feelings to peers for fear of being different or to adults because they may feel they will not understand. Therefore, adults may need to look for behaviors that stand out to indicate a youth may be struggling emotionally.

The following are indicators a child may need to see a therapist:
• Extreme or intense anger
• Slip in grades
• Isolating
• Change of friends
• Low opinion of self
• Lack of interest in activities
• Anxiousness
• Change in sleeping habits
• Poor concentration
• Behavior challenges in school
• Talking about death and dying
• Change of eating habits
• Avoiding family
• Change of appearance

These behaviors may not mean there is a problem, but nonetheless would be important to broach the subject with a child. Showing a child you care and want to listen to them go a long way with teenagers. If this discussion does not put you at ease, it would be advisable to introduce them to therapy. Even though a teenager may initially be reluctant to go to therapy, it still would be beneficial. If a teenager establishes a good connection with a therapist, they will understand therapy is a safe place for them to discuss their problems.