Study finds combination therapy successful for treating depression

Depression is common among opiate users and may serve as a trigger for high-risk drug injection practices, continued drug use, and relapse. Research has shown that individuals with co-occurring depression and substance use are less likely to complete treatment and have poorer prognoses after traditional treatment. However, scientists at the Brown University School of Medicine demonstrated that multisession, combination antidepressant therapy successfully reduced depression in active injection drug users.

Dr. Michael Stein and colleagues recruited 109 out-of-treatment injection drug users diagnosed with depression to participate in the study. Fifty-three participants received combined psychotherapy and pharmacotherapy for their depression during a 3-month period. These participants were scheduled to receive eight individual cognitive behavioral therapy (CBT) sessions and three pharmacotherapy visits. Fifty-six participants did not receive treatment. At the end of 3 months, adherence to treatment was assessed, and all study members participated in follow-up interviews designed to assess their heroin use and severity of depression.

Forty-three percent of participants receiving the combined treatment were considered to be fully adherent to their treatment schedules (receiving more than 75 percent of either psychotherapy or pharmacotherapy). At follow-up, significant reductions in depression were observed. Participants receiving the combined treatment were about 2.5 times more likely than those not receiving treatment to be in depression remission. Nearly 40 percent of participants who were fully adherent to treatment were in remission at 3 months, while only about 12 percent of those not receiving treatment were in remission at this time. Among all participants, depression status was associated with frequency of heroin use. Participants in remission at 3 months reported fewer than 8 days of heroin use during that time compared with roughly 13 days of heroin use among those not in remission.

WHAT IT MEANS: These findings indicate that depressed drug abusers are able to successfully participate in conventional treatment for depression, and for those who are adherent, depression remission is not uncommon. However, most mental health and drug treatment programs do not provide integrated treatment for their dually diagnosed patients. Developing and improving programs for patients with co-occurring depression and substance abuse disorders who do not seek drug treatment may be important as a potential prelude to entry into drug treatment.

The study was published in the February 2004 issue of the Archives of General Psychiatry. It was funded in part by NIDA.