Does comorbid substance use disorder impair recovery from major depression with SSRI treatment? An analysis of the STAR*D level one treatment outcomes

Lori L. Davis, Stephen R. Wisniewski, Robert H. Howland, Madhukar H. Trivedi, Mustafa M. Husain, Maurizio Fava, Patrick J. McGrath, G. K. Balasubramani, Diane Warden, A. John Rush

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)161-170
Number of pages10
JournalDrug and Alcohol Dependence
Volume107
Issue number2-3
DOIs
StatePublished - Mar 2010

Fingerprint

Serotonin Uptake Inhibitors
Substance-Related Disorders
Major Depressive Disorder
Citalopram
Alcohols
Depression
Recovery
Pharmaceutical Preparations
Antidepressive Agents
Therapeutics
Psychiatry
Hospitalization
Outpatients

Keywords

  • Alcohol use disorders
  • Citalopram
  • Comorbidity
  • Dual diagnosis
  • Major depression
  • Substance use disorders

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Toxicology
  • Pharmacology
  • Pharmacology (medical)

Cite this

Does comorbid substance use disorder impair recovery from major depression with SSRI treatment? An analysis of the STAR*D level one treatment outcomes. / Davis, Lori L.; Wisniewski, Stephen R.; Howland, Robert H.; Trivedi, Madhukar H.; Husain, Mustafa M.; Fava, Maurizio; McGrath, Patrick J.; Balasubramani, G. K.; Warden, Diane; Rush, A. John.

In: Drug and Alcohol Dependence, Vol. 107, No. 2-3, 03.2010, p. 161-170.

Research output: Contribution to journalArticle

Davis, Lori L. ; Wisniewski, Stephen R. ; Howland, Robert H. ; Trivedi, Madhukar H. ; Husain, Mustafa M. ; Fava, Maurizio ; McGrath, Patrick J. ; Balasubramani, G. K. ; Warden, Diane ; Rush, A. John. / Does comorbid substance use disorder impair recovery from major depression with SSRI treatment? An analysis of the STAR*D level one treatment outcomes. In: Drug and Alcohol Dependence. 2010 ; Vol. 107, No. 2-3. pp. 161-170.
@article{f2895e18eb774e76aaae4c2608fa1ce0,
title = "Does comorbid substance use disorder impair recovery from major depression with SSRI treatment? An analysis of the STAR*D level one treatment outcomes",
abstract = "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.",
keywords = "Alcohol use disorders, Citalopram, Comorbidity, Dual diagnosis, Major depression, Substance use disorders",
author = "Davis, {Lori L.} and Wisniewski, {Stephen R.} and Howland, {Robert H.} and Trivedi, {Madhukar H.} and Husain, {Mustafa M.} and Maurizio Fava and McGrath, {Patrick J.} and Balasubramani, {G. K.} and Diane Warden and Rush, {A. John}",
year = "2010",
month = "3",
doi = "10.1016/j.drugalcdep.2009.10.003",
language = "English (US)",
volume = "107",
pages = "161--170",
journal = "Drug and Alcohol Dependence",
issn = "0376-8716",
publisher = "Elsevier Ireland Ltd",
number = "2-3",

}

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

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

VL - 107

SP - 161

EP - 170

JO - Drug and Alcohol Dependence

JF - Drug and Alcohol Dependence

SN - 0376-8716

IS - 2-3

ER -