Home > Pharmacological treatment for depression during opioid agonist treatment for opioid dependence.

Pani, Pier Paolo and Vacca, Rosangela and Trogu, Emanuela and Amato, Laura and Davoli, Marina [The Cochrane Library] . (2010) Pharmacological treatment for depression during opioid agonist treatment for opioid dependence. John Wiley & Sons, Ltd. Cochrane Database of Systematic Reviews (9) DOI: 10.1002/14651858.CD008373.pub2

URL: http://onlinelibrary.wiley.com/o/cochrane/clsysrev...

Objectives: To evaluate the efficacy and the acceptability of antidepressants for the treatment of depressed opioid dependents treated with opioid agonists.

There is little evidence to support the use of antidepressants for treating people who are dependent on opioids and have clinical depression. Depression is more common in people with substance abuse and dependence than in the general population. The depression experienced is also associated with an increased risk of completed suicide. Depression may represent an independent disorder, the psychosocial stress associated with addictive behavior or it could be a consequence of drug use and drug withdrawal effects. A maintenance program with opioid agonists (methadone, buprenorphine, LAAM) is an effective treatment for people who are dependent on opioids in terms of retention in treatment and reduced use of opioids. Depression is however still prevalent and negatively impacts on treatment outcomes. Treatment with antidepressant drugs has therefore been proposed. These adjunct drug treatments include tricyclic antidepressants (doxepin, desipramine, imipramine) and selective serotonin reuptake inhibitors (SSRIs fluoxetine, sertraline).

Authors included seven randomised controlled studies that involved 482 participants in our review. The studies were conducted in outpatient settings over four to 16 weeks; six were in USA and one in Australia. The mean age of participants was 34 years and 62% were males. No clear difference was found in the number of dropouts from an opioid agonist maintenance program between people receiving antidepressants and those in the placebo groups. Neither was drug use different (two studies). Severity of depression was reduced with the use of antidepressants (two studies), including tricyclic antidepressants. Adverse events were important as more of the participants who received antidepressants withdrew from the studies for medical reasons compared with those participants on placebo (four studies).

The differences between studies in clinical (participant characteristics, the medications used, services and treatments delivered) and methodological characteristics (study design and quality) made it difficult to draw confident conclusions about the efficacy and safety of antidepressants for the treatment of depression in people who are dependent on opioids.

Item Type:Evidence resource
Publication Type:Review
Drug Type:Opioid
Intervention Type:AOD disorder drug therapy
Source:The Cochrane Library
Publisher:John Wiley & Sons, Ltd
Accession Number:HRB (Not in collection)
Subjects:J Health care, prevention and rehabilitation > Health care administration > Health care quality control
G Health and disease > State of health > Mental health
J Health care, prevention and rehabilitation > Care by type of problem > Mental health care
B Substances > Opioids (opiates)
HJ Treatment method > Substance disorder treatment method > Substance disorder drug therapy

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