Guía de práctica clínica para el tratamiento farmacológico y psicológico de los pacientes adultos con depresión y un diagnóstico comórbido de trastorno por uso de sustancias

  1. Marta Torrens
  2. Judit Tirado-Muñoz
  3. Francina Fonseca
  4. Magi Farré
  5. Ana González-Pinto
  6. Manuel Arrojo
  7. Miquel Bernardo
  8. Belén Arranz
  9. Marina Garriga
  10. Pilar A. Sáiz
  11. Gerardo Flórez
  12. José Manuel Goikolea
  13. Iñaki Zorrilla
  14. Ruth Cunill
  15. Xavier Castells
  16. Elisardo Becoña
  17. Ana López
  18. Luis San
Revue:
Adicciones: Revista de socidrogalcohol

ISSN: 0214-4840

Année de publication: 2022

Volumen: 34

Número: 2

Pages: 128-141

Type: Article

DIALNET GOOGLE SCHOLAR lock_openAccès ouvert editor

D'autres publications dans: Adicciones: Revista de socidrogalcohol

Résumé

Co-occurrence of depression and a substance use disorder (SUD) in patients who present dual diagnoses has been long recognized as an important consideration in clinical practice. This review synthesizes the evidence of pharmacological and psychosocial interventions for comorbid depressive disorders and SUDs while providing clinical recommendations about the best interventions to address these patients. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Our results suggest that 1) In patients with depression and alcohol consumption, the administration of non-selective serotonin reuptake inhibitor (SSRI) antidepressants instead of SSRI is recommended for improvement of depressive symptoms (strong recommendation). Neither SSRI (strong recommendation) nor non-SSRI (weak recommendation) antidepressants are recommended for reduction in alcohol consumption. 2) In patients with depression and cannabis use, the use of venlafaxine is not recommended (weak recommendation). 3) In patients with depression and cocaine consumption, the use of SSRI antidepressants for improving depressive symptoms (weak recommendation) or to reduce cocaine use is not recommended (strong recommendation). The use of non-SSRI antidepressants is only recommended for improving depressive symptoms (strong recommendation). 4) The administration of bupropion to reduce nicotine consumption is not recommended (strong recommendation). 5) Regarding psychological treatment, in patients with depression and co-occurring alcohol disorder, both pharmacotherapy and cognitive behavioural therapy have positive effects on internalizing symptoms and in reducing alcohol consumption (weak recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite evidence

Références bibliographiques

  • Afshar, M., Knapp, C. M., Sarid-Segal, O., Devine, E., Colaneri, L. S., Tozier, L.,... Ciraulo, D. A. (2012). The efficacy of mirtazapine in the treatment of cocaine dependence with comorbid depression. American Journal of Drug and Alcohol Abuse, 38, 181–186. doi:10.3109/00952990.2011.644002.
  • Agabio, R., Trogu, E. y Pani, P. P. (2018). Antidepressants for the treatment of people with co-occurring depression and alcohol dependence. The Cochrane Database of Systematic Reviews, 4, CD008581. doi:10.1002/14651858.CD008581.pub2.
  • Alías-Ferri, M., García-Marchena, N., Mestre-Pintó, J. I., Araos, P., Vergara-Moragues, E., Fonseca, F.,… Torrens, M. (2021). Cocaine and depressive disorders: When standard clinical diagnosis is insufficient. Adicciones, 33, 193-200. doi:10.20882/adicciones.1321.
  • Altamura, A. C., Mauri, M. C., Girardi, T. y Panetta, B. (1990). Alcoholism and depression: A placebo controlled study with viloxazine. International Journal of Clinical Pharmacology Research, 10, 293–298.
  • Boschloo, L., Vogelzangs, N., Smit, J. H., van den Brink, W., Veltman, D. J., Beekman, A. T. y Penninx, B. W. (2011). Comorbidity and risk indicators for alcohol use disorders among persons with anxiety and/or depressive disorders: Findings from the Netherlands Study of Depression and Anxiety (NESDA). Journal of Affective Disorders, 131, 233–242. doi:10.1016/j.jad.2010.12.014.
  • Caetano, R., Vaeth, P. A. C. y Canino, G. (2019). Comorbidity of lifetime alcohol use disorder and major depressive disorder in San Juan, Puerto Rico. Journal of Studies on Alcohol and Drugs, 80, 546–551. doi:10.15288/jsad.2019.80.546.
  • Carey, T. L. (2019). Use of antidepressants in patients with co-occurring depression and substance use disorders. Handbook of Experimental Pharmacology, 250, 359–370. doi:10.1007/164_2018_162.
  • Carton, L., Pignon, B., Baguet, A., Benradia, I., Roelandt, J.-L., Vaiva, G.,… Rolland, B. (2018). Influence of comorbid alcohol use disorders on the clinical patterns of major depressive disorder: A general population-based study. Drug and Alcohol Dependence, 187, 40–47. doi:10.1016/j.drugalcdep.2018.02.009.
  • Catley, D., Harris, K. J., Okuyemi, K. S., Mayo, M. S., Pankey, E. y Ahluwalia, J. S. (2005). The influence of depressive symptoms on smoking cessation among African Americans in a randomized trial of bupropion. Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco, 7, 859–870. doi:10.1080/14622200500330118.
  • Ciraulo, D., Knapp, C., Rotrosen, J., Sarid-Segal, O., Ciraulo, A. M., LoCastro, J.,… Leiderman, D. (2005). Nefazodone treatment of cocaine dependence with comorbid depressive symptoms. Addiction, 100 (Supl. 1), 23–31. doi:10.1111/j.1360-0443.2005.00984.x.
  • Compton, W. M., Thomas, Y. F., Stinson, F. S. y Grant, B. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 64, 830–842. doi.10.1001/archpsyc.64.5.566.
  • Conner, K. R., Pinquart, M. y Holbrook, A. P. (2008). Meta-analysis of depression and substance use and impairment among cocaine users. Drug and Alcohol Dependence, 98, 13–23. doi:10.1016/j.drugalcdep.2008.05.005.
  • Conner, K. R., Pinquart, M. y Gamble, S. A. (2009). Meta-analysis of depression and substance use among individuals with alcohol use disorders. Journal of Substance Abuse Treatment, 27, 127–137. doi:10.1016/j.gde.2016.03.011.
  • Cornelius, J. R., Salloum, I. M., Ehler, J. G., Jarrett, P. J., Cornelius, M. D., Black, A.,… Thase, M. E. (1997). Double-blind fluoxetine in depressed alcoholic smokers. Psychopharmacology Bulletin, 33, 165–170.
  • Cuenca-Royo, A. M., Torrens, M., Sánchez-Niubó, A., Suelves, J. M. y Domingo-Salvany, A. (2013). Psychiatric morbidity among young-adults cannabis users. Adicciones, 25, 45–53.
  • Evins, A. E., Culhane, M. A., Alpert, J. E., Pava, J., Liese, B. S., Farabaugh, A. y Fava, M. (2008). A controlled trial of bupropion added to nicotine patch and behavioral therapy for smoking cessation in adults with unipolar depressive disorders. Journal of Clinical Psychopharmacology, 28, 660–666. doi:10.1097/JCP.0b013e31818ad7d6.
  • Farré, A., Tirado-Muñoz, J. y Torrens, M. (2017). Dual depression: A sex perspective. Addictive Disorders & Their Treatment, 16, 180–186. doi:10.1097/ADT.0000000000000118.
  • Gopalakrishna, G., Langendam, M. W., Scholten, R. J., Bossuyt, P. M. y Leeflang, M. M. (2013). Guidelines for guideline developers: A systematic review of grading systems for medical tests. Implementation Science, 8, 78. doi:10.1186/1748-5908-8-78.
  • Gual, A., Balcells, M., Torres, M., Madrigal, M., Diez, T. y Serrano, L. (2003). Sertraline for the prevention of relapse in detoxicated alcohol dependent patients with a comorbid depressive disorder: A randomized controlled trial. Alcohol and Alcoholism, 38, 619–625. doi:10.1093/alcalc/agg124.
  • Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P. y Schünemann, H. J. (2008). GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 336, 924–926. doi:10.1136/bmj.39489.470347.AD.
  • Guyatt, G. H., Oxman, A. D., Kunz, R., Atkins, D., Brozek, J., Vist, G.,… Schünemann, H. J. (2011). GRADE guidelines: 2. Framing the question and deciding on important outcomes. Journal of Clinical Epidemiology, 64, 395–400. doi:10.1016/j.jclinepi.2010.09.012.
  • Hernandez-Avila, C. A., Modesto-Lowe, V., Feinn, R. y Kranzler, H. R. (2004). Nefazodone treatment of comorbid alcohol dependence and major depression. Alcoholism, Clinical and Experimental Research, 28, 433–440. doi:10.1097/01.ALC.0000118313.63897.EE.
  • Hesse, M. (2009). Integrated psychological treatment for substance use and co-morbid anxiety or depression vs. treatment for substance use alone. A systematic review of the published literature. BMC Psychiatry, 9, 6. doi:10.1186/1471-244X-9-6.
  • Hobbs, J. D. J., Kushner, M. G., Lee, S. S., Reardon, S. M. y Maurer, E. W. (2011). Meta-analysis of supplemental treatment for depressive and anxiety disorders in patients being treated for alcohol dependence. American Journal on Addictions, 20, 319–329. doi:10.1111/j.1521-0391.2011.00140.x.
  • Hunt, G. E., Malhi, G. S., Lai, H. M. X. y Cleary, M. (2020). Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990-2019: Systematic review and meta-analysis. Journal of Affective Disorders, 266, 288–304. doi:10.1016/j.jad.2020.01.141.
  • Iqbal, M. N., Levin, C. J. y Levin, F. R. (2019). Treatment for substance use disorder with co-occurring mental illness. Focus, 17, 88–97. doi:10.1176/appi.focus.20180042.
  • Jiménez-Treviño, L., Velasco, Á., Rodríguez-Revuelta, J., Abad, I., De La Fuente-Tomás, L., González-Blanco, L., … Sáiz, P. A. (2019). Factors associated with tobacco consumption in patients with depression. Adicciones, 31, 298–308. doi:10.20882/adicciones.1191.
  • Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry, 142, 1259–1264. doi:10.1176/ajp.142.11.1259.
  • Kranzler, H. R., Mueller, T., Cornelius, J., Pettinati, H. M., Moak, D., Martin, P. R.,… Keller, M. (2006). Sertraline treatment of co-occurring alcohol dependence and major depression. Journal of Clinical Psychopharmacology, 26, 13–20. doi:10.1097/01.jcp.0000194620.61868.35.
  • Lai, H. M. X., Cleary, M., Sitharthan, T. y Hunt, G. E. (2015). Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990-2014: A systematic review and meta-analysis. Drug and Alcohol Dependence, 1990–2014. doi:10.1016/j.drugalcdep.2015.05.031.
  • Levin, F. R., Mariani, J., Brooks, D. J., Pavlicova, M., Nunes, E. V., Agosti, V.,… Carpenter, K. M. (2013). A randomized double-blind, placebo-controlled trial of venlafaxine-extended release for co-occurring cannabis dependence and depressive disorders. Addiction, 108, 1084–1094. doi:10.1111/add.12108.
  • Mancino, M. J., McGaugh, J., Chopra, M. P., Guise, J. B., Cargile, C., Williams, D. K.,… Oliveto, A. (2014). Clinical efficacy of sertraline alone and augmented with gabapentin in recently abstinent cocaine-dependent patients with depressive symptoms. Journal of Clinical Psychopharmacology, 34, 234–239. doi:10.1097/JCP.0000000000000062.
  • Mason, B. J., Kocsis, J. H., Ritvo, E. C. y Cutler, R. B. (1996). A double-blind, placebo-controlled trial of desipramine for primary alcohol dependence stratified on the presence or absence of major depression. JAMA, 275, 761–767. doi:10.1001/jama.275.10.761.
  • McDowell, D., Nunes, E. V., Seracini, A. M., Rothenberg, J., Vosburg, S. K., Ma, G. J. y Petkova, E. (2005). Desipramine treatment of cocaine-dependent patients with depression: A placebo-controlled trial. Drug and Alcohol Dependence, 80, 209–221. doi:10.1016/j.drugalcdep.2005.03.026.
  • McGrath, P. J., Nunes, E. V, Stewart, J. W., Goldman, D., Agosti, V., Ocepek-Welikson, K. y Quitkin, F. M. (1996). Imipramine treatment of alcoholics with primary depression: A placebo-controlled clinical trial. Archives of General Psychiatry, 53, 232–240.
  • Moak, D. H., Anton, R. F., Latham, P. K., Voronin, K. E., Waid, R. L. y Durazo-Arvizu, R. (2003). Sertraline and cognitive behavioral therapy for depressed alcoholics: results of a placebo-controlled trial. Journal of Clinical Psychopharmacology, 23, 553–562. doi:10.1097/01.jcp.0000095346.32154.41.
  • Nunes, E. V., McGrath, P. J., Quitkin, F. M., Ocepek-Welikson, K., Stewart, J. W., Koenig, T.,… Klein, D. F. (1995). Imipramine treatment of cocaine abuse: Possible boundaries of efficacy. Drug and Alcohol Dependence, 39, 185–195. doi:10.1016/0376-8716%2895%2901161-6.
  • Oliveto, A., Poling, J., Mancino, M. J., Williams, D. K., Thostenson, J., Pruzinsky, R.,… Kosten, T. R. (2012). Sertraline delays relapse in recently abstinent cocaine-dependent patients with depressive symptoms. Addiction, 107, 131–141. doi:10.1111/j.1360-0443.2011.03552.x.
  • Pettinati, H. M., Volpicelli, J. R., Luck, G., Kranzler, H. R., Rukstalis, M. R. y Cnaan, A. (2001). Double-blind clinical trial of sertraline treatment for alcohol dependence. Journal of Clinical Psychopharmacology, 21, 143–153. doi:10.1097/00004714-200104000-00005.
  • Pettinati, H. M., Oslin, D. W., Kampman, K. M., Dundon, W. D., Xie, H., Gallis, T. L.,… O’Brien, C. P. (2010). A double-blind, placebo-controlled trial combining sertraline and naltrexone for treating co-occurring depression and alcohol dependence. American Journal of Psychiatry, 167, 668–675. doi:10.1176/appi.ajp.2009.08060852.
  • Raby, W. N., Rubin, E. A., Garawi, F., Cheng, W., Mason, E., Sanfilippo, L.,… Nunes, E. V. (2014). A randomized, double-blind, placebo-controlled trial of venlafaxine for the treatment of depressed cocaine-dependent patients. American Journal on Addictions, 23, 68–75. doi:10.1111/j.1521-0391.2013.12065.x.
  • Rappeneau, V. y Bérod, A. (2017). Reconsidering depression as a risk factor for substance use disorder: Insights from rodent models. Neuroscience and Biobehavioral Reviews, 77, 303–316. doi:10.1016/j.neubiorev.2017.04.001.
  • Riper, H., Andersson, G., Hunter, S. B., de Wit, J., Berking, M. y Cuijpers, P. (2014). Treatment of comorbid alcohol use disorders and depression with cognitive-behavioural therapy and motivational interviewing: A meta-analysis. Addiction, 109, 394–406. doi:10.1111/add.12441.
  • Roy-Byrne, P. P., Pages, K. P., Russo, J. E., Jaffe, C., Blume, A. W., Kingsley, E.,… Ries, R. K. (2000). Nefazodone treatment of major depression in alcohol-dependent patients: A double-blind, placebo-controlled trial. Journal of Clinical Psychopharmacology, 20, 129–136. doi:10.1097/00004714-200004000-00003.
  • Roy, A. (1998). Placebo-controlled study of sertraline in depressed recently abstinent alcoholics. Biological Psychiatry, 44, 633–637. doi:10.1016/S0006-3223%2897%2900509-X.
  • San, L. y Arranz, B. (2016). Clinical guideline for the treatment of dual pathology in the adult population. Adicciones, 28, 3-5. doi:10.20882/adicciones.784.
  • Schmitz, J. M., Averill, P., Stotts, A. L., Moeller, F. G., Rhoades, H. M. y Grabowski, J. (2001). Fluoxetine treatment of cocaine-dependent patients with major depressive disorder. Drug and Alcohol Dependence, 63, 207–214. doi:10.1016/S0376-8716(00)00208-8.
  • Schnoll, R., Martinez, E., Tatum, K. L., Weber, D. M., Kuzla, N., Glass, M.,… Leone, F. (2010). A bupropion smoking cessation clinical trial for cancer patients. Cancer Causes and Control, 21, 811–820. doi:10.1007/s10552-010-9507-8.
  • Schuckit, M. A. (2006). Comorbidity between substance use disorders and psychiatric conditions. Addiction, 101 (Supl. 1), 76–88. doi:10.1111/j.1360-0443.2006.01592.x.
  • Schünemann, H. J., Oxman, A. D., Brozek, J., Glasziou, P., Jaeschke, R., Vist, G. E.,… Guyatt, G. H. (2008). Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ, 336, 1106–1110. doi:10.1136/bmj.39500.677199.AE.
  • Sobell, L. y Sobell, M. (1992). Timeline follow-back: A technique for assessing self-reported alcohol consumption. En R. Z. Litten y J. P. Allen (Eds.), Measuring Alcohol Consumption (pp. 41–72). Totowa, NJ: Humana Press.
  • Tirado-Muñoz, J., Farré, A., Mestre-Pintó, J., Szerman, N. y Torrens, M. (2018). Dual diagnosis in depression: Treatment recommendations. Adicciones, 30, 66–76. doi:10.20882/adicciones.868.
  • Torrens, M., Fonseca, F., Mateu, G. y Farre, M. (2005). Efficacy of antidepressants in substance use disorders with and without comorbid depression: A systematic review and meta-analysis. Drug and Alcohol Dependence, 78, 1–22. doi:10.1016/j.drugalcdep.2004.09.004.
  • Torrens, M., Martínez-Sanvisens, D., Martínez-Riera, R., Bulbena, A., Szerman, N. y Ruiz, P. (2011). Dual diagnosis: Focusing on depression and recommendations for treatment. Addictive Disorders & Their Treatment, 10, 50–59. doi:10.1097/ADT.0b013e318215f322.
  • Torrens, M., Rossi, P. C., Martinez-Riera, R., Martinez-Sanvisens, D. y Bulbena, A. (2012). Psychiatric co-morbidity and substance use disorders: Treatment in parallel systems or in one integrated system. Substance Use and Misuse, 47, 1005–1014. doi:10.3109/10826084.2012.663296.
  • Vázquez, F. L., Torres, Á., Otero, P. y Díaz, O. (2011). Prevalence, comorbidity, and correlates of DSM-IV axis I mental disorders among female university students. The Journal of Nervous and Mental Disease, 199, 379–383. doi:10.1097/NMD.0b013e31821cd29c.
  • Vergara-Moragues, E., González-Saiz, F., M. Lozano, O., Betanzos Espinosa, P., Fernández Calderón, F., Bilbao-Acebos, I.,… Verdejo García, A. (2012). Psychiatric comorbidity in cocaine users treated in therapeutic community: Substance-induced versus independent disorders. Psychiatry Research, 200, 734–741. doi:10.1016/j.psychres.2012.07.043.
  • Ziedonis, D. M. y Kosten, T. R. (1991). Depression as a prognostic factor for pharmacological treatment of cocaine dependence. Psychopharmacology Bulletin, 27, 337–343.
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