Alcohol use disorder and depression: proposed rewording of Choosing Wisely recommendation

Tanguay, Robert L.; Lamba, Wiplove; Fraser, R. S. S.; Mills, Phillip; Azarbar, Ataa; el‐Guebaly, Nady

doi:10.1503/cmaj.732873

Cited by 2 publications

(2 citation statements)

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“…While this recommendation appears to be logically sound and reasonable, there are quite a few counter-arguments to this proposition. 27 First of all, the effectiveness of treatment of AUD tends to be quite low even in cases of patients with only 1 diagnosis -recent meta-analysis yielded a small, but significant effect size and the number needed to treat for naltrexone and acamprosate of 7.5 and 8.6, respectively 28 and it tends to be even lower in depressed patients with AUD who tend not to adhere to antidipsotropic medications and to show even poorer response to treatment protocols. 18 Additionally, the etiology of depressive episodes may be unclear in many cases and, as longitudinal studies show, a significant portion of apparently alcohol-induced depressive episodes are being later reclassified into independent ones.…”

Section: Differential Diagnosis Between Major Depressive and Alcohol-...mentioning

confidence: 99%

“…Choosing Wisely Canada 26 recommendation is to first consider the possibility of a period of sobriety and subsequent reassessment for the persistence of depressive symptoms, which at least in theory would allow for a) complete differentiation between alcohol-induced mood disorder and concurrent MDD, b) assessment of the severity of independent mood disturbances, and c) better treatment compliance when abstinent. While this recommendation appears to be logically sound and reasonable, there are quite a few counter-arguments to this proposition 27 …”

Section: Introductionmentioning

confidence: 96%

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Theory and Practice of Treatment of Concurrent Major Depressive and Alcohol Use Disorders: 7 Lessons from Clinical Practice and Research

Samokhvalov

2021

Canadian Journal of Addiction

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Objectives: Both major depression and alcohol use are highly prevalent in the Canadian population. They are the major contributors to disability and decreased quality of life and, as they are often comorbid with each other, the diagnosis and treatment of concurrent depression and alcohol use disorder represent a challenging task with multiple clinical questions requiring evidence-based recommendations. Thus, the goal of this article is to review the optimal strategies to treat concurrent alcohol use and major depressive disorders in the context of current research findings and clinical practice. Methods: Narrative review, knowledge synthesis, and secondary data analysis. Results: Based on the review of the relevant literature and secondary data analyses of our own clinical data, we devised a set of pragmatic clinical recommendations and guidance on differential diagnosis between alcohol-induced mood disorder and independent major depressive disorder concurrent with alcohol use disorder, the choice and timing of pharmacological agents, organization of care, selection of best-evidence psychotherapeutic approaches and their integration into clinical practice, management of patients’ and team expectations in terms of clinical outcomes, as well as the implementation of measurement-based approaches to optimize care delivery and achieve better clinical outcomes. Conclusions: Seven clinically relevant problems were reviewed and the evidence-based ready-to-implement clinical approaches were offered. Objectifs: La dépression majeure et la consommation d’alcool sont très répandues dans la population canadienne. Ils sont les principaux contributeurs à l’invalidité et à la diminution de la qualité de vie et, comme ils sont souvent comorbides les uns avec les autres, le diagnostic et le traitement de la dépression concomitante et des troubles liés à la consommation d’alcool représentent une tâche difficile avec de multiples questions cliniques nécessitant des recommandations fondées sur des preuves. Ainsi, le but de cet article est d’examiner les stratégies optimales pour traiter la consommation concomitante d’alcool et les troubles dépressifs majeurs dans le contexte des résultats de recherche actuels et de la pratique clinique. Méthodes: Revue narrative, synthèse des connaissances, analyse des données secondaires. Résultats: Sur la base de la revue de la littérature pertinente et des analyses de données secondaires de nos propres données cliniques, nous avons conçu un ensemble de recommandations cliniques pragmatiques et de conseils sur le diagnostic différentiel entre les troubles de l’humeur induits par l’alcool et les troubles dépressifs majeurs indépendants concomitants avec les troubles liés à la consommation d’alcool, le choix et le timing des agents pharmacologiques, l’organisation des soins, la sélection des approches psychothérapeutiques les plus probantes et leur intégration dans la pratique clinique, la gestion des attentes des patients et des équipes en terme de résultats cliniques ainsi que la mise en œuvre d’approches basées sur la mesure afin d’optimiser la prestation des soins et obtenir de meilleurs résultats cliniques. Conclusions: Sept problèmes cliniquement pertinents ont été examinés et des approches cliniques fondées sur des preuves prêtes à être mises en œuvre ont été proposées.

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Section: Differential Diagnosis Between Major Depressive and Alcohol-...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%