Psychiatric Annals

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CME Article 

Treatment of Co-occurring Depression and Substance Dependence: Using Meta-analysis to Guide Clinical Recommendations

Edward V. Nunes, MD; Frances R. Levin, MD

Abstract

Depression is a common phenomenon among patients with alcohol or drug dependence, as is evident to any practitioner working with these patients. Numerous studies have documented high rates of depressive disorders among patients seeking treatment for substance use disorders. Community surveys have consistently found elevated rates of major depression and dysthymia among patients with alcohol or drug dependence. Further, current major depression has been associated with worse clinical outcome among substance-dependent patients. The data are less clean on the prognostic implications of a past depression or elevated depressive symptoms without identification of a depressive disorder. These epidemiological data suggest that a co-occurring depressive disorder is important and warrants clinical attention.

ABOUT THE AUTHORS

Edward V. Nunes, MD; and Frances R. Levin, MD, are with the Columbia University College of Physicians and Surgeons, and N.Y. State Psychiatric Institute, New York.

Address correspondence to: Edward V. Nunes, MD, 1051 Riverside Drive (Unit 51), New York, NY 10032; or e-mail nunesed@pi.cpmc.columbia.edu.

Dr. Nunes and Dr. Levin have disclosed no relevant financial relationships.

Research in this article has been supported by Grants P50 DA09236 and K24 DA022412 (Dr. Nunes) and K02 000465 (Dr Levin).

EDUCATIONAL OBJECTIVES

  1. To understand how meta-analysis can be used to evaluate antidepressant treatment efficacy for depression in substance abusers seeking treatment.
  2. To gain knowledge of what methodologic features of pharmacologic treatment trials targeting depressed substance abusers predict better treatment response.
  3. To understand recommendations derived from findings of placebo-controlled antidepressant medication trials for clinical management and treatment of depressed, substance-dependent patients.

Abstract

Depression is a common phenomenon among patients with alcohol or drug dependence, as is evident to any practitioner working with these patients. Numerous studies have documented high rates of depressive disorders among patients seeking treatment for substance use disorders. Community surveys have consistently found elevated rates of major depression and dysthymia among patients with alcohol or drug dependence. Further, current major depression has been associated with worse clinical outcome among substance-dependent patients. The data are less clean on the prognostic implications of a past depression or elevated depressive symptoms without identification of a depressive disorder. These epidemiological data suggest that a co-occurring depressive disorder is important and warrants clinical attention.

ABOUT THE AUTHORS

Edward V. Nunes, MD; and Frances R. Levin, MD, are with the Columbia University College of Physicians and Surgeons, and N.Y. State Psychiatric Institute, New York.

Address correspondence to: Edward V. Nunes, MD, 1051 Riverside Drive (Unit 51), New York, NY 10032; or e-mail nunesed@pi.cpmc.columbia.edu.

Dr. Nunes and Dr. Levin have disclosed no relevant financial relationships.

Research in this article has been supported by Grants P50 DA09236 and K24 DA022412 (Dr. Nunes) and K02 000465 (Dr Levin).

EDUCATIONAL OBJECTIVES

  1. To understand how meta-analysis can be used to evaluate antidepressant treatment efficacy for depression in substance abusers seeking treatment.
  2. To gain knowledge of what methodologic features of pharmacologic treatment trials targeting depressed substance abusers predict better treatment response.
  3. To understand recommendations derived from findings of placebo-controlled antidepressant medication trials for clinical management and treatment of depressed, substance-dependent patients.

Depression is a common phenomenon among patients with alcohol or drug dependence, as is evident to any practitioner working with these patients. Numerous studies have documented high rates of depressive disorders among patients seeking treatment for substance use disorders. Community surveys have consistently found elevated rates of major depression and dysthymia among patients with alcohol or drug dependence. Further, current major depression has been associated with worse clinical outcome among substance-dependent patients. The data are less clean on the prognostic implications of a past depression or elevated depressive symptoms without identification of a depressive disorder. These epidemiological data suggest that a co-occurring depressive disorder is important and warrants clinical attention.

ABOUT THE AUTHORS

Edward V. Nunes, MD; and Frances R. Levin, MD, are with the Columbia University College of Physicians and Surgeons, and N.Y. State Psychiatric Institute, New York.

Address correspondence to: Edward V. Nunes, MD, 1051 Riverside Drive (Unit 51), New York, NY 10032; or e-mail nunesed@pi.cpmc.columbia.edu.

Dr. Nunes and Dr. Levin have disclosed no relevant financial relationships.

Research in this article has been supported by Grants P50 DA09236 and K24 DA022412 (Dr. Nunes) and K02 000465 (Dr Levin).

EDUCATIONAL OBJECTIVES

  1. To understand how meta-analysis can be used to evaluate antidepressant treatment efficacy for depression in substance abusers seeking treatment.
  2. To gain knowledge of what methodologic features of pharmacologic treatment trials targeting depressed substance abusers predict better treatment response.
  3. To understand recommendations derived from findings of placebo-controlled antidepressant medication trials for clinical management and treatment of depressed, substance-dependent patients.

10.3928/00485713-20081101-05

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