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Early Life Adversity as a Moderator of Symptom Change following Selective Serotonin Reuptake Inhibitors and Cognitive

Meredith A Gruhn^1,2, K Luan Phan³, Heide Klumpp¹

¹Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.

Cognitive Therapy and Research

|April 16, 2025

Abstract

Background:

Early Life Adversity (ELA) is consistently linked to chronic, treatment-resistant depression and anxiety. Selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) represent the two first-line treatments for internalizing disorders. However, little is known about the efficacy of these therapies for individuals with ELA, particularly within heterogeneous cohorts of patients with high levels of comorbidity.

Methods:

Treatment seeking adults with depression and/or anxiety were randomized to twelve weeks of SSRI (n = 46) or CBT (n = 50), and internalizing disorder symptoms were assessed pre- and post-treatment. Individuals with and without ELA were included.

Results:

Both SSRI and CBT resulted in reductions in internalizing symptoms, as expected. A significant ELA by treatment type interaction for depression, but not anxiety, also emerged. Individuals with a positive history of ELA had a greater reduction in depression symptoms following SSRIs compared with CBT. In contrast, individuals with a negative history of ELA had a greater reduction in depression symptoms following CBT compared with SSRIs.

Conclusions:

Findings suggest that SSRIs may be particularly effective for individuals with ELA and CBT may be particularly effective for individuals without ELA in reducing depression, but not anxiety, symptoms. Clinical implications and future directions are discussed.

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