Antidepressants for Major Depressive Disorder and Dysthymic Disorder in Patients With Comorbid Alcohol Use Disorders

Iovieno, Nadia; Tedeschini, Enrico; Bentley, Kate H.; Evins, A. Eden; Papakostas, George I.

doi:10.4088/jcp.10m06217

Cited by 73 publications

(70 citation statements)

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“…Even if comorbid mental health problems are adequately detected, treatment options for this client group seem to have fairly modest benefits. Pharmacological treatments for depression in alcohol and drug users appear to have mixed evidence, with some reviews that indicate a beneficial effect (Iovieno, Tedeschini, Bentley, Evins, & Papakostas, 2011;Nunes & Levin, 2004) and other reviews that question their efficacy (Lingford- Hughes, Welch, & Nutt, 2012;Pedrelli et al, 2011;Torrens, Fonseca, Mateu, & Farré, 2005). In view of such evidence, exploring the potential of psychological treatments may be a fruitful avenue for research and practice.…”

Section: Introductionmentioning

confidence: 95%

Feasibility Randomized Controlled Trial of Cognitive and Behavioral Interventions for Depression Symptoms in Patients Accessing Drug and Alcohol Treatment

Delgadillo

Gore²,

Ali

et al. 2015

Journal of Substance Abuse Treatment

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Depressed mood often co-exists with frequent drug and alcohol use. This trial examined the feasibility of screening, recruitment, randomization and engagement of drug and alcohol users in psychological interventions for depression symptoms. A total of 50 patients involved in community drugs and alcohol treatment (CDAT) were randomly allocated to behavioral activation delivered by psychological therapists (n = 23) or to cognitive behavioral therapy based self-help introduced by CDAT workers (n = 27). We examined recruitment and engagement rates, as well as changes in depression (PHQ-9) symptoms and changes in percent days abstinent (PDA within last month) at 24 weeks follow-up. The ratio of screened to recruited participants was 4 to 1, and the randomization schedule successfully generated 2 groups with comparable characteristics. Follow-up was possible with 78% of participants post-treatment. Overall engagement in psychological interventions was low; only 42% of randomized participants attended at least 1 therapy session. Patients offered therapy appointments co-located in CDAT clinics were more likely to engage with treatment (odds ratio = 7.14, p = .04) compared to those offered appointments in community psychological care clinics. Intention-to-treat analyses indicated no significant between-group differences at follow-up in mean PHQ-9 change scores (p = .59) or in PDA (p = .08). Overall, it was feasible to conduct a pragmatic trial within busy CDAT services, maximizing external validity of study results. Moderate and comparable improvements in depression symptoms over time were observed for participants in both treatment groups.

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Section: Introductionmentioning

confidence: 95%

Feasibility Randomized Controlled Trial of Cognitive and Behavioral Interventions for Depression Symptoms in Patients Accessing Drug and Alcohol Treatment

Delgadillo

Gore²,

Ali

et al. 2015

Journal of Substance Abuse Treatment

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Section: Introductionmentioning

confidence: 99%

“…Similarly, a meta-analysis by Lovieno et al (2011) concluded that the SSRIs have not shown efficacy in comorbid populations. Those same authors (Lovieno et al, 2011) also noted the complete lack of studies involving a number of newer antidepressants, such as mirtazapine, for treating comorbid populations. Importantly, mirtazapine was found to be superior to other antidepressant medications for treating depression in a large meta-analysis of 12 new-generation antidepressants (Cipriani et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Mirtazapine in comorbid major depression and an alcohol use disorder: A double-blind placebo-controlled pilot trial

Cornelius

Chung

Douaihy

et al. 2016

Psychiatry Research

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This was a first double-blind, placebo-controlled pilot study to evaluate the efficacy of the novel antidepressant medication mirtazapine for treating both the depressive symptoms and the level of alcohol consumption of subjects with comorbid major depressive disorder and an alcohol use disorder (MDD/AUD). The results of two previous studies of mirtazapine in MDD/AUD subjects had suggested efficacy for mirtazapine for decreasing their level of depressive symptoms, but level of alcohol consumption had not been assessed in those studies. All subjects in this 12-week pilot study were randomized to either mirtazapine or placebo, and also received motivational enhancement therapy. Between-group analyses involving the outcome measures of depressive symptoms, level of alcohol consumption, and level of alcohol craving indicated no significant differences between groups, possibly because of limited sample size. However, within-group t tests in the mirtazapine group showed a significant decrease in depressive symptoms by week 2, also noted at all subsequent assessments (weeks 3, 4, 6, 8, 10, and 12) during the 12-week study. In contrast, no significant decrease in depressive symptoms was noted in the placebo group until week 8. No evidence of efficacy was found for mirtazapine for decreasing level of alcohol consumption in MDD /AUD subjects.

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“…Three meta-analyses examine pharmacotherapy of alcohol-use disorders and depressive disorders with broadly similar conclusions (Iovieno et al, 2011;Torrens et al, 2005) (Ia). The meta-analysis by found significant or trend antidepressant effects in 8/14 studies (effect size of 0.38, 95% CI 0.18-0.58).…”

Section: Alcohol and Depression Depressive And Anxiety Symptomsmentioning

confidence: 99%

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

Welch²,

et al. 2012

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The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short-and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people. KeywordsSubstance misuse, addiction, guidelines, pharmacotherapy, comorbidity 1 Imperial College London, CNWL NHS Foundation Trust, London, UK 2 Gether NHS Foundation Trust, Gloucester, UK 3 Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UKOther invited participants at the consensus meeting who contributed to the discussion and commented on the guidelines were Drummond C, Farrell M, Gilvarry E, Strang J. John, a user representative, read and commented on the written guidelines. Prof W van den Brink reviewed the written guidelines.

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Antidepressants for Major Depressive Disorder and Dysthymic Disorder in Patients With Comorbid Alcohol Use Disorders

Abstract: These results support the utility of certain antidepressants (tricyclics, nefazodone) in treating depression in patients with comorbid alcohol use disorders. More data on the use of newer antidepressants, including the SSRIs, for this select patient population are needed.

Cited by 73 publications

References 0 publications

Feasibility Randomized Controlled Trial of Cognitive and Behavioral Interventions for Depression Symptoms in Patients Accessing Drug and Alcohol Treatment

Feasibility Randomized Controlled Trial of Cognitive and Behavioral Interventions for Depression Symptoms in Patients Accessing Drug and Alcohol Treatment

Mirtazapine in comorbid major depression and an alcohol use disorder: A double-blind placebo-controlled pilot trial

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

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