Childhood abuse and neglect is an insidious problem with far-reaching consequences. According to the U.S. Department of Health and Human Services Administration for Children and Families, in 2007 close to 800,000 children were determined to be victims of neglect or abuse. These statistics likely underestimate the actual incidence of abuse because an unknown but significant amount of abuse is never reported or investigated. Abuse has devastating, enduring effects on children. Adults who were abused as children continue to suffer from their childhood trauma. One of the many effects of childhood abuse is treatment-resistant depression.
Types of Abuse
The forms of childhood abuse include neglect, emotional abuse, physical abuse and sexual abuse. The lion's share of abuse and neglect takes place within the home. Younger children and infants are particularly vulnerable as they lack the physical, emotional, verbal and social resources to defend themselves or to obtain help. Emotional abuse and neglect are harder to substantiate legally but have insidious effects on individuals and on society. All forms of childhood abuse cause immediate harm and have lasting effects. In many cases, victims of childhood abuse become perpetrators of abuse, continuing the cycle of abuse and victimization of children.
Effects of Abuse
Children who are abused experience symptoms of trauma, including anxiety, depression, difficulties at school or work, anger, aggression, cognitive and learning deficits, medical illness, social withdrawal, impulsivity, sexual activity at an early age and difficulty maintaining close relationships. Victims of childhood abuse are at higher risk for substance abuse, arrest, incarceration and legal problems.
Physiological effects include impairment of regions of the brain that regulate emotions and memory and sensitization of physiological stress response mechanisms. For example, according to a report in the December 2002 "American Journal of Psychiatry," women with histories of chronic childhood abuse and trauma have a smaller left hippocampus volume--a region of the brain involved in spatial memory--than non-depressed and non-childhood traumatized women. Similarly, women with childhood histories of abuse excrete greater amounts of the stress hormone cortisol in response to stress than do women who do not have childhood trauma. These varied effects of abuse often persist into adulthood.
Treatment-Resistant Depression
Treatment-resistant depression is depression that does not respond to psychotherapy and pharmacologic treatment. A history of childhood abuse contributes to the development of treatment-resistant depression. Childhood abuse probably reduces response to treatment because of its effect on underlying physiological mechanisms of depression such as memory and emotional arousal systems.
Also, abuse typically produces multiple, simultaneous, psychiatric conditions that complicate treatment. Further, childhood abuse increases resistance to treatment because of the severity of its impact on beliefs, expectations, attitudes and other cognitive habits. Finally, the common behavioral outcomes of abuse such as social withdrawal, difficulty maintaining long-term relationships, sexual acting out, substance abuse and criminal behavior often lead victims of abuse to create unhealthy lifestyles. These lifestyles and self-created social environments contribute to, maintain and exacerbate depression.
Treating Treatment-Resistant Depression
When depression is complicated, it is important to pursue multidisciplinary treatment options that address the many contributing causes. Medications should be taken exactly as prescribed, and emotional stress needs to be addressed effectively, as do underlying health problems, maladaptive behavior patterns and simultaneous psychiatric conditions.
Advanced Alternative Treatments
If traditional therapies fail, alternative therapies should be considered. Often the mechanisms are not well understood, but various alternative treatments have been found to be effective for treating resistant depression. These interventions, which are generally administered by neurologists or other medical specialists, include vagus nerve stimulation (VNS), electroconvulsive shock therapy (ECT), transcranial magnetic stimulation (TMS), magnetic stimulation (MST) and deep brain stimulation (DBS). Eye movement desensitization and reprocessing (EMDR) is administered by specially trained counselors and therapists.
