Treatment of major depressive disorder and dysthymic disorder with
antidepressants in patients with comorbid opiate use disorders enrolled in
methadone maintenance therapy: a meta-analysis.
Author(s): Pedrelli P, Iovieno N, Vitali M, Tedeschini E, Bentley KH, Papakostas GI.
Affiliation(s): Department of Psychiatry, Massachusetts General Hospital and Harvard Medical
School, Boston, MA 02114, USA. ppedrelli@partners.org
Publication date & source: 2011, J Clin Psychopharmacol. , 31(5):582-6
Depression and opiate-use disorders (abuse, dependence) often co-occur, each
condition complicating the course and outcome of the other. It has been
recommended that clinicians prescribe antidepressant therapy for mood symptoms in
patients with active substance-use disorders, but whether antidepressants are
effective in this specific population is not entirely clear. Therefore, the aim
of this study was to examine the efficacy of antidepressants in patients with
unipolar major depressive disorder (MDD) and/or dysthymic disorder (DD) with
comorbid opiate-use disorders currently in methadone maintenance treatment (MMT).
Medline/PubMed publication databases were searched for randomized, double-blind,
placebo-controlled trials of antidepressants used as monotherapy for the
treatment of MDD/DD in patients with comorbid opiate-use disorders currently in
MMT. The search was limited to articles published between January 1, 1980, and
June 30, 2010 (inclusive). Four manuscripts were found eligible for inclusion in
our analysis (n = 317 patients). We found no statistically significant difference
in response rates between antidepressant and placebo therapy in trials of MDD/DD
patients with comorbid opiate-use disorders currently in MMT (risk ratio for
response, 1.182; 95% CI: 0.822-1.700; P = 0.366). These results show no
difference in the depressive outcome of patients with comorbid opiate-use
disorders on MMT whether they are on medication or placebo. Future studies
examining the effectiveness of antidepressants while controlling for several
variables such as psychosocial treatment and assessing the specific classes of
antidepressants are needed.
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