A meta-analysis of 14 studies involving patients with co-occurring depression and alcohol or drug abuse suggests that using antidepressant medication to treat people with these disorders is beneficial, but that clinicians also should use concurrent therapy specifically targeting the addiction.
Dr. Edward Nunes and Dr. Frances Levin analyzed 14 studies that examined whether symptoms of depression respond to antidepressant medication in substance-addicted people and the impact of such treatment on concurrent substance abuse. The studies included 848 patients with depression and drug addictions. Eight trials recruited alcoholic patients, four recruited methadone-maintained, opiate-addicted patients, and two recruited cocaine-addicted patients. All of the studies were randomized, double-blind, and placebo-controlled.
The researchers found that antidepressant medication exerts a beneficial effect on depression in patients with alcohol or drug addiction, especially when the medications are used at adequate doses, for at least 6 weeks, and for depressive syndromes identified by clinical history and established diagnostic criteria. Their analysis also showed that even when medication is effective in treating depression, it helps bring about only a modest decrease in substance abuse. For this reason, they recommend clinicians also use therapies that directly treat the addiction.
Clinicians working with patients who have co-occurring drug abuse and depression may be reluctant to initiate antidepressant treatment because of a belief the depression may be temporary, or concern that focus on depression will detract from the treatment of substance abuse. This analysis supports recent recommendations that drug or alcohol abuse are not barriers to treating depression. The researchers also suggest additional research is needed to refine diagnostic methods that would allow clinicians to better distinguish substance abuse patients who would benefit from antidepressant therapy.
The scientists, both with the New York State Psychiatric Institute and Columbia University, published their findings in the April 21, 2004 issue of the Journal of the American Medical Association. Their research was partly funded by NIDA.