Refractory depression tied to substance use disorder

  • Brenner P & al.
  • Addiction
  • 1 Apr 2019

  • International Clinical Digest
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Takeaway

  • Patients with treatment-resistant major depressive disorder (MDD) are at increased risk of developing a substance use disorder (SUD).
  • Risk is higher among those with no history of SUD.

Why this matters

  • Treatment-resistant depression is common, with 10%-20% of patients with MDD reporting no response to initial antidepressant therapy and up to 60% unable to achieve remission after treatment.

Study design

  • Study of 121,669 patients with MDD.
  • Funding: Söderström-Königska Foundation; Thuring Foundation.

Key results

  • 12.8% of the patients had treatment-resistant depression.
  • In patients without prior SUD history, treatment-resistant depression was associated with SUD risk:
    • ≤1 year after treatment initiation (HR, 1.51; 95% CI, 1.4-1.7).
    • >1 year after treatment initiation (HR, 1.39; 95% CI, 1.3-1.5).
    • Opioid (HR, 1.9; 95% CI,1.4-2.5) and sedatives (HR, 2.7; 95% CI, 2.2-3.2) were implicated. 
  • In patients with a history of SUD, treatment-resistant depression was associated with a higher risk for SUD:
    • ≤1 year after treatment initiation (HR, 1.23; 95% CI, 1.1-1.4).
    • >1 year after treatment initiation (HR, 1.15; 95% CI, 1.0-1.3).
    • Sedative (>1 year HR,  2.0 [95% CI, 1.3-3.0]) and multiple substance use (HR, 1.9; 95% CI,1.4-2.5) subcategories were implicated.

Limitations

  • Retrospective design.

Coauthored with Antara Ghosh, PhD

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