Agitated depression in substance dependence

Abstract

Background Depression with psychomotor agitation (PMA; “agitated depression”) is a putative psychiatric phenotype that appears to associate with some forms of substance dependence. However, it is unclear whether such relationships extend across different substances and independent (I-MDE) versus substance-induced (SI-MDE) subtypes of major depressive episodes. Method We examined whether lifetime depression with (vs. without) PMA was associated with lifetime substance dependence across individuals with lifetime: (1) I-MDE only (n = 575); and (2) SI-MDE only (n = 1683). Data were pooled from several family and genetic studies of substance dependence in which participants received identical structured interviews to diagnose DSM-IV mental disorders. Results In I-MDE, PMA was significantly associated with alcohol, cocaine, opioid, other drug (hallucinogen, inhalant, speed-ball), and sedative dependence. After controlling for demographic and clinical co-factors, PMA's relationship to dependence on opioids, other drugs, and sedatives remained significant, but not its relationship to alcohol or cocaine. In SI-MDE, PMA was significantly associated with alcohol, cocaine, opioid, and other drug dependence. After adjusting for co-factors, associations remained significant for dependence on cocaine and opioids, but not alcohol or other drugs. Relationships between PMA and opioid dependence were stronger in I-MDE than SI-MDE. Depression subtype (I-MDE vs. SI-MDE) did not moderate relations between PMA and non-opioid forms of substance dependence. Conclusions Agitated depression associates with certain forms of substance dependence, particularly opioid dependence. MDE subtype did not alter most PMA-dependence associations, which suggests that the mechanisms underlying this comorbidity are complex and potentially bidirectional.

The impact of mood symptomatology on pattern of substance use among homeless

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Changes in Depression Subtypes Among Men in STAR*D: A Latent Transition Analysis

“…Despite previous work focused on psychomotor agitation and retardation, it remains unclear if both symptoms are core features of melancholia only or are shared across subtypes (Benazzi, 2002). Furthermore, agitation is also associated with mood switching in unipolar depression (Iwanami et al, 2015) and with comorbid substance dependence (Leventhal et al, 2011), highlighting the need to determine how to improve treatment to resolve specific symptoms.…”

Smoking‐related correlates of psychomotor restlessness and agitation in a community sample of daily cigarette smokers

“…Depression with (vs. without) PMA tends to re‐occur across multiple depressive episodes and exhibits a unique pattern of correlations with demographic characteristics, other depressive symptoms, and several non‐depressive psychiatric conditions . In samples of depressed individuals, the prevalence depression with (vs. without) PMA ranges from 31.3% (vs. 68.4%) to 52.1% (vs. 47.9%) . Hence, investigating PMA as a stand‐alone phenotype may aid in isolating the source of psychopathological risk for addictions that is not uncommon in the population.…”

“…4,5 In samples of depressed individuals, the prevalence depression with (vs. without) PMA ranges from 31.3% (vs. 68.4%) to 52.1% (vs. 47.9%). [5][6][7] Hence, investigating PMA as a stand-alone phenotype may aid in isolating the source of psychopathological risk for addictions that is not uncommon in the population.…”