Elsevier

Biological Psychiatry

Volume 56, Issue 10, 15 November 2004, Pages 793-802
Biological Psychiatry

Impact of substance abuse on the diagnosis, course, and treatment of mood disorders
Treatment of depression in patients with opiate dependence

https://doi.org/10.1016/j.biopsych.2004.06.037Get rights and content

Depression is common among opiate-dependent patients and has been associated with worse prognosis. This article reviews the literature on treatment of depressive disorders and symptoms among patients with opiate dependence. Depression bears a complex relationship to opiate dependence and may represent an independent disorder or may be engendered by psychosocial stress or toxic and withdrawal effects of drugs. Primary treatments for opiate dependence (e.g., methadone or buprenorphine maintenance or residential treatment) are associated with substantial improvements in depression. Studies of antidepressant medications have produced mixed results, some positive but more negative. It is not clear what accounts for these differences, and more research is needed to determine how to select opiate-dependent patients most likely to benefit from antidepressants. Fewer studies have examined psychosocial or behavioral interventions, but some of these also show promise. The data suggest a stepped model of care in which depression is evaluated and observed during the outset of treatment for opiate dependence and if it does not improve, specific psychosocial interventions or antidepressant medications tried. Research is needed on such integrated models of care and treatment algorithms to determine their efficacy and cost effectiveness.

Section snippets

Relationships between opiates and mood

The classic effect of opiates in patients who are in pain is both to relieve pain and to relieve the dysphoria associated with pain. Among medical patients receiving analgesic doses, these changes are described as decreased anxiety, drowsiness, and a sense of tranquility (Jaffe and Martin 1990). Opiate-dependent individuals describe feelings of well-being that may be energizing or relaxing in quality. Opioid medications produce their pleasant effects by stimulating the brain reward system

Summary of findings

Depression is prevalent in opiate-dependent patients. Its etiology and relationship to opiate dependence is complex, but evidence suggests that depression in this population has adverse prognostic effects and also may be a factor in motivating patients to seek treatment for their drug problems. Depressive symptoms often improve after entry into treatment for opiate dependence, a finding which may represent a direct pharmacologic effect in the case of methadone or buprenorphine maintenance, an

References (71)

  • K.L. Preston et al.

    Improvement in naltrexone treatment compliance with contingency management

    Drug Alcohol Depend

    (1999)
  • C.A. Roeloffs et al.

    Problem substance use among depressed patients in managed primary care

    Psychosomatics

    (2002)
  • J.L. Rothenberg et al.

    Behavioral naltrexone therapyAn integrated treatment for opiate dependence

    J Subst Abuse Treat

    (2002)
  • B.J. Rounsaville et al.

    Long-term changes in current psychiatric diagnoses of treated opiate addicts

    Compr Psychiatry

    (1986)
  • J. Zacny et al.

    College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abusePosition statement

    Drug Alcohol Depend

    (2003)
  • I.O. Arndt et al.

    Desipramine treatment of cocaine dependence in methadone-maintained patients

    Arch Gen Psychiatry

    (1992)
  • J.A. Bodkin et al.

    Buprenorphine treatment of refractory depression

    J Clin Psychopharmacol

    (1995)
  • M. Borenstein et al.

    Comprehensive Meta-Analysis

    (1999)
  • N.L. Brehm et al.

    Psychodynamics

  • R.K. Brooner et al.

    Psychiatric and substance use comorbidity among treatment-seeking opioid abusers

    Arch Gen Psychiatry

    (1997)
  • K.M. Carroll et al.

    Targeting behavioral therapies to enhance naltrexone treatment of opioid dependenceEfficacy of contingency management and significant other involvement

    Arch Gen Psychiatry

    (2001)
  • J. Cohen

    Statistical Power Analysis for the Behavioral Sciences

    (1988)
  • T.J. Crowley et al.

    Naltrexone-induced dysphoria in former opiate addicts

    Am J Psychiatry

    (1985)
  • G. DeLeon et al.

    Phoenix HouseChanges in psychopathological signs of resident addicts

    Arch Gen Psychiatry

    (1973)
  • G. DeLeon

    Therapeutic communities

  • W. Fals-Stewart et al.

    Behavioral family counseling and naltrexone for male opioid-dependent patients

    J Consult Clin Psychol

    (2003)
  • B. Frank

    An overview of heroin trends in New York CityPast, present and future

    Mt Sinai J Med

    (2000)
  • E.L. Gardner

    Brain reward mechanisms

  • D.R. Gerstein

    Outcome researchDrug abuse

  • G. Gonzalez et al.

    Comorbid major depressive disorder as a prognostic factor in cocaine-abusing buprenorphine-maintained patients treated with desipramine and contingency management

    Am J Drug Alcohol Abuse

    (2003)
  • M. Gossop et al.

    A prospective study of mortality among drug misusers during a 4-year period after seeking treatment

    Addiction

    (2002)
  • E.W. Gunderson et al.

    Treatment of pain in drug-addicted persons

  • S. Hamilton et al.

    Treatment of depressed methadone maintenance patients with Nefazodone. A case series

    Am J Addict

    (1998)
  • D.S. Hasin et al.

    Comorbidity of alcohol, drug, and psychiatric disordersEpidemiology

  • D. Hasin et al.

    Effects of major depression on remission and relapse of substance dependence

    Arch Gen Psychiatry

    (2002)
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