TY - JOUR
T1 - Does comorbid substance use disorder impair recovery from major depression with SSRI treatment? An analysis of the STAR*D level one treatment outcomes
AU - Davis, Lori L.
AU - Wisniewski, Stephen R.
AU - Howland, Robert H.
AU - Trivedi, Madhukar H.
AU - Husain, Mustafa M.
AU - Fava, Maurizio
AU - McGrath, Patrick J.
AU - Balasubramani, G. K.
AU - Warden, Diane
AU - Rush, A. John
N1 - Funding Information:
Patrick J. McGrath, MD has received research support from National Institute of Mental Health, National Institute on Alcohol Abuse and Alcoholism, New York State Department of Mental Hygiene, NARSAD, Research Foundation for Mental Hygiene (New York State), GlaxoSmithKline, Eli Lilly, Organon, and Lipha Pharmaceuticals; and has been a consultant for GlaxoSmithKline, Somerset Pharmaceuticals, Novartis Pharmaceuticals, Sanofi Aventis, and Roche .
Funding Information:
Madhukar H. Trivedi, MD has received consultant or speaker fees from Abbott Laboratories, Inc., Abdi Brahim, Akzo (Organon Pharmaceuticals, Inc.), AstraZeneca, Bristol-Myers Squibb Company Cephalon, Inc., Fabre-Kramer Pharmaceuticals, Inc., Forest Pharmaceuticals, GlaxoSmithKline, Janssen Pharmaceutica Products, LP, Johnson & Johnson PRD, Eli Lilly & Company, Meade Johnson, Neuronetics, Parke-Davis Pharmaceuticals, Inc., Pfizer, Inc., Sepracor, VantagePoint, and Wyeth-Ayerst Laboratories, and research support from Agency for Healthcare Research and Quality, Corcept Therapeutics, Inc., Cyberonics, Inc., Merck, National Alliance for Research in Schizophrenia and Depression, National Institute of Mental Health, National Institute on Drug Abuse, Novartis, Pharmacia & Upjohn, Predix Pharmaceuticals, Solvay Pharmaceuticals, Inc., and Targacept .
Funding Information:
Lori L Davis, MD has received research funding from NIMH, VA, Department of Defense, Abbott Laboratories, Bristol-Myers Squibb (BMS), Eisai Pharmaceuticals, Forest Laboratories, Ortho McNeil Pharmaceutical, Janssen, Shire, AstraZeneca, Southwestern Oncology Group; consultant fees from Cyberonics, Abbott, BMS, Shire, Eli Lilly & Company; and speaking honorarium from Abbott Laboratories, Cyberonics, BMS, Sanofi-Aventis ; and previously held equity in Pfizer.
Funding Information:
A. John Rush, MD has served as a consultant for Advanced Neuromodulation Systems, AstraZeneca, Best Practice Project Management, Bristol-Myers Squibb/Otsuka, Cyberonics, Forest Pharmaceuticals, Gerson Lehrman Group, GlaxoSmithKline, Jazz Pharmaceuticals, Merck & Company, Neuronetics, Novartis Pharmaceuticals, Magellan Health Services, Otsuka Pharmaceuticals, Ono Pharmaceuticals, Organon, Pamlab, Transcept Pharmaceuticals, Urban Institute, and Wyeth Ayerst; as received royalties as an author from Guilford Publications and Healthcare Technology Systems has served as a consultant and is a stock holder with Pfizer; and has received research funding from National Institute of Mental Health and Stanley Medical Research Institute.
Funding Information:
Maurizio Fava, MD has or has received research support from Abbott Laboratories, Alkermes, Aspect Medical Systems, Astra-Zeneca, Bristol-Myers Squibb Company, Cephalon, Eli Lilly & Company, Forest Pharmaceuticals Inc., Ganeden, GlaxoSmithkline, J&J Pharmaceuticals, Lichtwer Pharma GmbH, Lorex Pharmaceuticals, NARSAD, NCCAM, NIDA, NIMH, Novartis, Organon Inc., PamLab, LLC, Pfizer, Inc., Pharmavite, Roche, Sanofi-Aventis, Shire, Solvay Pharmaceuticals, Inc., Synthelabo, Wyeth-Ayerst Laboratories; advisory or consulting fees from Abbott Laboratories, Amarin), Aspect Medical Systems, Astra-Zeneca, Auspex Pharmaceuticals, Bayer AG, Best Practice Project Management, Inc., Biovail Pharmaceuticals, Inc., BrainCells, Inc., Bristol-Myers Squibb Company, Cephalon, Clinical Trials Solutions, CNS Response, Compellis, Cypress Pharmaceuticals, Dov Pharmaceuticals, Eli Lilly & Company, EPIX Pharmaceuticals, Fabre-Kramer, Pharmaceuticals, Inc., Forest Pharmaceuticals Inc., GlaxoSmithkline, Grunenthal GmBH Janssen Pharmaceutica, Jazz Pharmaceuticals, J&J Pharmaceuticals, Knoll Pharmaceutical Company, Labopharm, Lorex Pharmaceuticals, Lundbeck, MedAvante Inc. Merck, Methylation Sciences, Neuronetics, Novartis, Nutrition 21, Organon Inc., PamLab, LLC, Pfizer Inc., PharmaStar, Pharmavite, Precision Human Biolaboratory, Roche, Sanofi-Aventis, Sepracor, Solvay Pharmaceuticals, Inc., Somaxon, Somerset Pharmaceuticals, Synthelabo, Takeda, Tetragenex, Transcept Pharmaceuticals, Vanda Pharmaceuticals Inc., Wyeth-Ayerst Laboratories; speaking fees from Advanced Meeting Partners, American Psychiatric Association, Astra-Zeneca, Boehringer-Ingelheim, Bristol-Myers Squibb Company, Cephalon, Eli Lilly & Company, Forest Pharmaceuticals Inc., GlaxoSmithkline, Imedex, Novartis, Organon Inc., Pfizer Inc., PharmaStar, MGH Psychiatry Academy/Primedia, MGH Psychiatry Academy/Reed-Elsevier); UBC, Wyeth-Ayerst Laboratories ; equity holdings in Compellis; and royalty/patent or other income from patent applications for SPCD and for a combination of azapirones and bupropion in MDD, copyright royalties for the MGH CPFQ, SFI, ATRQ, DESS, and SAFER.
Funding Information:
Mustafa M. Husain, MD has received research support from the National Institute of Mental Health, Stanley Medical Research Institute, Cyberonics, Inc., Neuronetics, Inc., Magstim, and Advanced Neuromodulation Systems . He has served on Advisory Boards or speakers bureaus for Cyberonics, Inc., Avinar, Inc., Cerebrio, Inc., AstraZeneka, Bristol-Meyers-Squibb, Optima/Forrest Pharmaceuticals, Glaxo-Smith-Kline, Forest Pharmaceuticals, and Janssen.
Funding Information:
Robert H. Howland, MD has received research funding from Aspect Medical Systems; Northstar Neuroscience; Bristol-Myers Squibb; Cyberonics; National Institutes of Health; National Center for Complementary and Alternative Medicine; Novartis .
Funding Information:
This project has been funded with Federal funds from the National Institute of Mental Health, National Institutes of Health , under Contract N01MH90003 to UT Southwestern Medical Center at Dallas (P.I.: A.J. Rush). This study is registered at www.ClinicalTrials.gov , identifier number NCT00021528 . The NIMH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
PY - 2010/3
Y1 - 2010/3
N2 - Many patients with major depressive disorder (MDD) present with concurrent substance use disorders (SUDs), which has been thought to impair their response to antidepressants. Clinicians often delay antidepressant treatment until sustained sobriety has been established. Unfortunately, these comorbid subjects are typically excluded from depression treatment trials, leaving a gap in understanding the treatment outcomes. In the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, 2876 adult outpatients diagnosed with nonpsychotic MDD were prospectively treated with the selective serotonin-reuptake inhibitor (SSRI), citalopram, and returned for at least one post-baseline visit. Participants with SUD (29%) and without SUD (71%) were compared in regard to baseline clinical and sociodemographic features and treatment response. The group with MDD and SUD was further subdivided into those with alcohol only, drug only, and both alcohol and drug use. Despite clear sociodemographic and clinical differences, there were no significant differences between groups in the time to achieve response or rates of response to citalopram; however, those who endorsed both alcohol and drug use had significantly reduced rates of remission and significantly increased times to reach remission compared to the MDD group without SUD. In addition, subjects with MDD and SUD had higher risk of psychiatric serious adverse events (3.3% vs. 1.5%) and hospitalization (2.8% vs. 1.2%). The results indicate that first-line treatment with citalopram in depressed patients with alcohol or drug use respond as well as those without SUD. More intensive treatment is most likely needed for MDD patients with both drug and alcohol use disorders.
AB - Many patients with major depressive disorder (MDD) present with concurrent substance use disorders (SUDs), which has been thought to impair their response to antidepressants. Clinicians often delay antidepressant treatment until sustained sobriety has been established. Unfortunately, these comorbid subjects are typically excluded from depression treatment trials, leaving a gap in understanding the treatment outcomes. In the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, 2876 adult outpatients diagnosed with nonpsychotic MDD were prospectively treated with the selective serotonin-reuptake inhibitor (SSRI), citalopram, and returned for at least one post-baseline visit. Participants with SUD (29%) and without SUD (71%) were compared in regard to baseline clinical and sociodemographic features and treatment response. The group with MDD and SUD was further subdivided into those with alcohol only, drug only, and both alcohol and drug use. Despite clear sociodemographic and clinical differences, there were no significant differences between groups in the time to achieve response or rates of response to citalopram; however, those who endorsed both alcohol and drug use had significantly reduced rates of remission and significantly increased times to reach remission compared to the MDD group without SUD. In addition, subjects with MDD and SUD had higher risk of psychiatric serious adverse events (3.3% vs. 1.5%) and hospitalization (2.8% vs. 1.2%). The results indicate that first-line treatment with citalopram in depressed patients with alcohol or drug use respond as well as those without SUD. More intensive treatment is most likely needed for MDD patients with both drug and alcohol use disorders.
KW - Alcohol use disorders
KW - Citalopram
KW - Comorbidity
KW - Dual diagnosis
KW - Major depression
KW - Substance use disorders
UR - http://www.scopus.com/inward/record.url?scp=77649187826&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77649187826&partnerID=8YFLogxK
U2 - 10.1016/j.drugalcdep.2009.10.003
DO - 10.1016/j.drugalcdep.2009.10.003
M3 - Article
C2 - 19945804
AN - SCOPUS:77649187826
SN - 0376-8716
VL - 107
SP - 161
EP - 170
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
IS - 2-3
ER -