Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-16T15:21:45.013Z Has data issue: false hasContentIssue false
  • English
  • Français

Achieving Remission and Favorable Outcomes in Patients with Depression/Anxiety and Substance use Disorders

Published online by Cambridge University Press:  07 November 2014

Alan F. Schatzberg
Get access Rights & Permissions [Opens in a new window]

Extract

Given the frequency with which patients with substance use disorders (SUDs) and those with psychiatric disorders, such as major depressive disorder (MDD) and generalized anxiety disorder (GAD), suffer relapses and recurrences, the issue of long-term treatment for SUDs warrants special attention. Faced with recommending long-term treatment, the clinician must discern the primacy of disorder, which may have been only obliquely addressed at the time of the patient's presentation and then solved by concurrent treatment. Establishing primacy relies on determining whether the psychiatric symptoms were induced by SUD or the psychiatric disorder emerged first and substance use was a means of coping with it. A third possibility exists—that the two disorders developed independently of each other, albeit becoming intermingled over time and serving to exacerbate each other. Clues to the temporal relationship of the disorders can be deduced from a meticulous history obtained from multiple sources, the effects that acute treatment has had on either condition, and the patient's willingness to remain abstinent from the addictive substance. Hasin and colleagues demonstrated the importance that a history of depression has on long-term remission and relapse outcomes in substance dependence (Slide 1).

Type
Expert Roundtable Supplement
Information
CNS Spectrums , Volume 13 , Issue S6: Bridging the Clinical Gap: Managing Patients with Co-occurring Mood, Anxiety, and Alcohol Use Disorders , April 2008 , pp. 10 - 12
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.American Psychiatric Association. Practice Guideline for the Treatment of Patients with Substance Use Disorders. 2nd ed.New York, NY: American Psychiatric Association; 2006.Google Scholar
2.Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text revision. Washington, DC: American Psychiatric Association; 2004:372–474.Google Scholar
3.Yonkers, KA, Warshaw, MG, Massion, AO, Keller, MB.Phenomenology and course of generalised anxiety disorder. Br J Psychiatry. 1996;168(3):308–313.CrossRefGoogle ScholarPubMed
4.Lehman, AF, Myers, CP, Corty, E.Assessment and classification of patients with psychiatric and substance abuse syndromes. Psychiatr Serv. 2000;51(9):1119–1125.CrossRefGoogle ScholarPubMed
5.Hasin, D, Liu, X, Nunes, E, McCloud, S, Samet, S, Endicott, J.Effects of major depression on remission and relapse of substance dependence. Arch Gen Psychiatry. 2002;59(4):375–380.CrossRefGoogle ScholarPubMed
6.Compton, WM 3rd, Cottler, LB, Jacobs, JL, Ben-Abdallah, A, Spitznagel, EL.The role of psychiatric disorders in predicting drug dependence treatment outcomes. Am J Psychiatry. 2003;160(5):890–895.CrossRefGoogle ScholarPubMed
7.Charney, DA, Palacios-Boix, J, Negrete, JC, Dobkin, PL, Gill, KJ.Association between concurrent depression and anxiety and six-month outcome of addiction treatment. Psychiatr Serv. 2005;56(8):927–933.CrossRefGoogle ScholarPubMed
8.Practice guideline for the treatment of patients with major depressive disorder (revision). American Psychiatric Association. Am J Psychiatry. 2000;157(4 Suppl):1–45.Google Scholar
9.Kessler, RC, Berglund, P, Demler, O, et al. National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095–3105.CrossRefGoogle ScholarPubMed
10.Fricchione, G.Generalized anxiety disorder. N Engl J Med. 2004;351(7):675–682.CrossRefGoogle ScholarPubMed
11.Physicians Desk Reference 2006: Guide to Drug Interactions, Side Effects, and Indications. 60th ed. Montvale, NJ: Thomson PDR; 2006:1177–3418.Google Scholar
12.Brady, KT.Evidence-Based Pharmacotherapy for Mood and Anxiety Disorders with Concurrent Alcoholism. CNS Spectr. 2008;13:4(Suppl 6):7–9.CrossRefGoogle ScholarPubMed
13.Davidson, JR, Bose, A, Wang, Q.Safety and efficacy of escitalopram in the long-term treatment of generalized anxiety disorder. J Clin Psychiatry. 2005;66(11):1441–1446.CrossRefGoogle ScholarPubMed
14.Allgulander, C, Huusom, AK, Florea, I.Prevention of relapse in generalized anxiety disorder by escitalopram treatment. Int J Neuropsychopharmacol. 2006;9(5):495–505.CrossRefGoogle ScholarPubMed
15.Stocchi, F, Nordera, G, Jokinen, RH, et al. Efficacy and tolerability of paroxetine for the longterm treatment of generalized anxiety disorder. J Clin Psychiatry. 2003;64(3):250–258.CrossRefGoogle ScholarPubMed
16.Bielski, RJ, Bose, A, Chang, CC.A double-blind comparison of escitalopram and paroxetine in the long-term treatment of generalized anxiety disorder. Ann Clin Psychiatry. 2005;17(2):65–69.CrossRefGoogle ScholarPubMed
17.Montgomery, SA, Sheehan, DV, Meoni, P, Haudiquet, V, Hackett, D.Characterization of the longitudinal course of improvement in generalized anxiety disorder during long-term treatment with venlafaxine XR. J Psychiatr Res. 2002;36(4):209–217.CrossRefGoogle ScholarPubMed
18.Suh, JJ, Pettinati, HM, Kampman, KM, O'Brien, CP.The status of disulfiram: a half of a century later. J Clin Psychopharmacol. 2006;26(3):290–302.CrossRefGoogle ScholarPubMed
19.Naranjo, CA, Sellers, EM.Serotonin uptake inhibitors attenuate ethanol intake in problem drinkers. Recent Dev Alcohol. 1989:7:255–266.CrossRefGoogle ScholarPubMed
20.Kranzler, HR, Mueller, T, Cornelius, J, et al. Sertraline treatment of co-occurring alcohol dependence and major depression. J Clin Psychopharmacol. 2006;26(1):13–20.CrossRefGoogle ScholarPubMed
21.Krampe, H, Stawicki, S, Wagner, T, et al. Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome. Alcohol Clin Exp Res. 2006:30(1):86–95.CrossRefGoogle ScholarPubMed
22.Anton, RF, O'Malley, SS, Ciraulo, DA, et al. Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. 2006;295(17):2003–2017.CrossRefGoogle ScholarPubMed
23.Pelc, I, Le Bon, O, Verbanck, P, Lehert, PH, Opsomer, L. Calcium acetyl homotaurinate for maintaining abstinence in weaned alcoholic patients: A placebo-controlled double-blind multicentre study. In: Naranjo, C, Sellers, E, ed. Novel Pharmacological Interventions for Alcoholism. New York, NY: Springer-Verlag; 1992:348–352.CrossRefGoogle Scholar
24.Ladewig, D, Knecht, T, Leher, P, Fendl, A.Acamprosate--a stabilizing factor in long-term withdrawal of alcoholic patients (in German). Ther Umsch. 1993;50(3):182–188.Google Scholar
25.Geerlings, PJ, Ansoms, C, van den Brink, W.Acamprosate and prevention of relapse in alcoholics. Eur Addict Res. 1997;3:129–137.CrossRefGoogle Scholar
26.Poldrugo, F.Acamprosate treatment in a long-term community-based alcohol rehabilitation programme. Addiction. 1997;92(11):1537–1546.CrossRefGoogle Scholar
27.Chick, J, Howlett, H, Morgan, MY, Ritson, B.United Kingdom Multicentre Acamprosate Study (UKMAS): a 6-month prospective study of acamprosate versus placebo in preventing relapse after withdrawal from alcohol. Alcohol Alcohol. 2000;35(2):176–187.CrossRefGoogle ScholarPubMed
28.Tempesta, E, Janiri, L, Bignamini, A, Chabac, S, Potgieter, A.Acamprosate and relapse prevention in the treatment of alcohol dependence: a placebo-controlled study. Alcohol Alcohol. 2000;35(2):202–209.CrossRefGoogle ScholarPubMed
29.Gual, A, Lehert, P.Acamprosate during and after acute alcohol withdrawal: a double-blind placebo-controlled study in Spain. Alcohol Alcohol. 2001;36(5):413–418.CrossRefGoogle ScholarPubMed
30.Mason, BJ, Goodman, AM, Chabac, S, Lehert, P.Effect of oral acamprosate on abstinence in patients with alcohol dependence in a double-blind, placebo-controlled trial: the role of patient motivation. J Psychiatr Res. 2006;40(5):383–393.CrossRefGoogle Scholar
31.Barrias, JA, Chabac, S, Ferreira, L, Fonte, A, Potgieter, AS, Teixeira de Sousa, E.Acamprosate: multicenter Portuguese efficacy and tolerance evaluation study. Psiquiatr. Clín. 1997;18:149–160.Google Scholar
32.Paille, FM, Guelfi, JD, Perkins, AC, Royer, RJ, Steru, L, Parot, P.Double-blind randomized multicentre trial of acamprosate in maintaining abstinence from alcohol. Alcohol Alcohol. 1995;30(2):239–247.Google ScholarPubMed
33.Sass, H, Soyka, M, Mann, K, Zieglgänsberger, W.Relapse prevention by acamprosate. Results from a placebo-controlled study on alcohol dependence. Arch Gen Psychiatry. 1996;53(8):673–680.CrossRefGoogle Scholar
34.Whitworth, AB, Fischer, F, Lesch, OM, et al. Comparison of acamprosate and placebo in longterm treatment of alcohol dependence. Lancet. 1996;347(9013):1438–1442.CrossRefGoogle ScholarPubMed
35.Besson, J, Aeby, F, Kasas, A, Lehert, P, Potgieter, A.Combined efficacy of acamprosate and disulfiram in the treatment of alcoholism: a controlled study. Alcohol Clin Exp Res. 1998;22(3):573–579.CrossRefGoogle ScholarPubMed