Use of Antidepressants in Patients with Co-occurring Depression and Substance Use Disorders.

This chapter reviews antidepressant treatment considerations and recommendations for patients with co-occurring depression and substance use disorders. Depression and substance use disorders are highly comorbid conditions. Substance use disorders are chronic disorders that result in a cluster of symptoms indicating that an individual continues to use a substance despite significant problems resulting from their use. About 17 million Americans have an alcohol use disorder, and another approximately 7 million individuals have other drug use disorders (not including alcohol) in the United States. The rate of any substance use disorder (including alcohol) in individuals with major depressive disorder is 32% based on a national survey. Evidence suggests that the best outcome for individual with co-occurring conditions is treating both conditions simultaneously. Therefore, practitioners should know the following before prescribing antidepressants for patients with co-occurring substance use disorders: (1) treatment recommendations for patients with co-occurring depression and substance use disorders, (2) potential antidepressant interactions with alcohol and drugs of abuse, and (3) do antidepressants have a risk of misuse? Finally, we will summarize antidepressant treatment recommendations for patients with co-occurring depression and substance use disorders.

Racially related health disparities and alcoholism treatment outcomes.

Published studies comparing the outcomes of black and white patients with alcohol dependence have produced mixed results. We hypothesized that among alcoholic outpatients blacks would have worse outcomes than whites. A sample of 38 blacks and 136 whites were assessed prospectively at baseline and 6-12 months using a naturalistic study design. At baseline, blacks had less education, employment, and income than whites, and they were less likely to be married. They also were more likely to have family histories of substance abuse, previous episodes of treatment, cocaine use disorders, antisocial personality disorder, and poor physical health. Between baseline and follow-up, blacks received less treatment for alcohol dependence than whites. Such differences would seem to favor worse outcomes which were not found. Blacks, however, reported more social support for sobriety than whites. They also had better rates of study retention than whites, suggestive of either higher levels of motivation or stronger alliances with the treatment center. Future studies of racial differences should include measures of social support for sobriety, motivation for treatment, and treatment alliance.