Associations between depression subtypes and substance use disorders

Abstract

Evaluating whether certain subtypes of Major Depressive Disorder (MDD) are more strongly associated with Substance Use Disorders (SUDs) may help clarify reasons for MDD-SUD relations. Therefore, this study compared DSM-IV-defined non-atypical/non-melancholic depression (undifferentiated depression; n=365), atypical depression (n=117), melancholic depression (n=245), and atypical-melancholic depression (n=68) in the prevalence of current SUDs, while controlling for relevant demographic and clinical variables. Psychiatric outpatients with a current diagnosis of unipolar MDD were assessed using the Structured Clinical Interview for DSM-IV, supplemented by questions from the Schedule for Affective Disorders and Schizophrenia. Results showed that compared with patients with undifferentiated depression, melancholic patients had higher rates of current nicotine dependence (34% vs. 26%) and drug abuse/dependence (8% vs. 3%), Ps<0.05. These differences were explained by the association between specific melancholic features (marked psychomotor agitation and weight loss/decreased appetite) and nicotine and drug use disorders. Atypical depression, atypical-melancholic depression, and other subtype symptoms were not significantly associated with any SUDs. Although this study is limited by low prevalence of alcohol and drug use disorders, the present findings suggest that different symptomatic expressions of MDD differentially associate with some SUDs.

Smoking, nicotine and neuropsychiatric disorders

“…According to the current results of Leventhal et al (2008Leventhal et al ( , 2009, some depressive symptoms are more strongly linked with nicotine dependence than others (Leventhal et al, 2008(Leventhal et al, , 2009. Namely, symptoms of the melancholic subtype of major depression are associated more strongly with NIC dependence than symptoms of atypical depression (melancholic and atypical depression are DSM-IV-based subtypes of major depression and differ from each other in some of their symptoms) (Leventhal et al, 2008(Leventhal et al, , 2009). …”

Prospective Relations Between Melancholia and Substance Use Disorders

“…One potential barrier to understanding this relationship is MDD's heterogeneity. Accordingly, several studies have examined the relationship between SUDs and different subtypes of MDD (2)(3)(4). This research approach may elucidate potential mechanisms of MDD-SUD comorbidity and shed light on the risk profiles of dual-diagnosis individuals.…”

“…The melancholic subtype of MDD (5), which is characterized by pervasive anhedonia and neurovegetative features, is associated with drug use disorders but not alcohol use disorders (2)(3)(4). These findings are interesting because both melancholic MDD and drug addiction are thought to be underpinned by dysregulation of the mesocorticolimbic dopamine and hypothalamic-pituitary-adrenal axis pathways (6,7).…”

Depression and Anxiety Symptoms Moderate the Relation Between Negative Reinforcement Smoking Outcome Expectancies and Nicotine Dependence

“…Multiple studies have also shown that higher pre-quit depressive and anxiety symptoms and syndromes predict poorer smoking outcomes (Brown et al, 2001;Cinciripini et al, 2003;Haas et al, 2004;Leventhal et al, 2008a;Piper et al, 2010Piper et al, , 2011Zvolensky et al, 2008). Similarly, negative reinforcement expectancies have been shown to predict cessation success (Correa-Fernández et al, 2012;Wetter et al, 1994).…”