Brief reportA randomised, controlled trial of fluoxetine in methadone maintenance patients with depressive symptoms
Introduction
Comorbid depression is prevalent in methadone maintenance patients (MMPs) (Brooner et al., 1997) and is related to poor psychosocial outcomes, needle sharing and relapse (Rounsaville et al., 1982, Rounsaville et al., 1986, Crawford, 1996).
Antidepressant trials in MMPs have had mixed results. Some studies (e.g. Nunes et al., 1998) found an antidepressant to be superior to placebo, whilst others (Kleber et al., 1983, Petrakis et al., 1998) reported no differences between antidepressant and placebo.
The effects of antidepressants on substance use are also unclear, especially benzodiazepine use, which is common in Australian MMPs (Darke et al., 1993). This study examined the efficacy of fluoxetine in reducing depression and substance use in MMPs, and whether improved mood assisted in reducing substance use.
Section snippets
Subjects
Self-referred subjects were screened using the Beck Depression Inventory (BDI) (Beck et al., 1961); those scoring above 21 were eligible to participate. Given the difficulty diagnosing depression in substance users (Kranzler et al., 1995), the tendency for antidepressants to be prescribed for substance use (Olfson et al., 1998), and high rates of antidepressant use in this population (Roszell and Calsyn, 1986, Darke and Ross, 2000), the sample was intended to represent MMPs for whom
Results
Forty-nine subjects (33 men) were randomised (age range 23–49 years). Subject characteristics are detailed in Table 1. There were no differences between subjects receiving fluoxetine and placebo.
Fifteen subjects did not complete the study (10 on fluoxetine). Non-completers were more likely to have used antidepressants before (P<0.05) and tended to have higher initial BDI scores (P=0.059) than completers. No other differences were observed.
Using ITT analysis, depressive symptoms and functioning
Discussion
Fluoxetine had no differential effect on depressive symptoms. Both placebo and fluoxetine groups displayed improvement in depressive symptoms over time, suggesting that first-line use of fluoxetine in MMPs with depressive symptoms may not be appropriate. Some relationships were observed between mood and drug use, but these remain inconclusive. The relationship between depression, substance use and antidepressant use remains to be clarified.
Our findings, similar to those of Petrakis et al. (1998)
Acknowledgements
Eli Lilly Ltd. provided financial support. We thank Bayside Clinic, Clinic 36, Rankin Court, The Langton Centre; and John Saunders for his helpful criticism. The late David Mascord will be remembered and appreciated for his friendship and support.
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