Pharmacotherapy plus psychotherapy for treatment of depression in active injection drug users.
BACKGROUND
Depressive disorders are common among opiate abusers and are associated with detrimental behavioral effects. However, there is little precedent for offering active drug users complex treatments for depression.


OBJECTIVE
To determine whether combined psychotherapy and pharmacotherapy treatment reduces reported depressive symptoms compared with an assessment-only condition among out-of-treatment drug injectors.


METHODS
Randomized controlled trial.


METHODS
Research office located at an academic medical center.


METHODS
Active injection drug users with a DSM-IV diagnosis of major depression, dysthymia, substance-induced mood disorder with symptoms persisting for at least 3 months, or major depression plus dysthymia, and a Modified Hamilton Rating Scale for Depression (HAM-D) score greater than 13.


METHODS
Combined psychotherapy (8 sessions of cognitive behavior therapy) plus pharmacotherapy (citalopram).


METHODS
Modified HAM-D scale scores at the end of 3 months of combined treatment.


RESULTS
The 109 study subjects were 64% male and had a mean age of 36.7 years and a mean baseline HAM-D score of 20.7. Depression subtypes included major depression only (63%), substance-induced depression (17%), and major depression plus dysthymia (17%). In the intent-to-treat analysis, participants in treatment averaged 2.11 HAM-D points greater improvement than control subjects (P=.08), and 26.1% of combined treatment patients (n=53) compared with 12.5% of control patients (n=56) were in remission (P=.047). Nearly 40% of fully adherent subjects (receiving >75% of either psychotherapy or pharmacotherapy) were in remission at follow-up (odds ratio, 3.6; P=.04).


CONCLUSIONS
Combined treatment for depression is significantly superior to a control condition (assessment only) in proportion of patients in remission, but not in HAM-D improvement among drug injectors. Full adherence to treatment is associated with the largest treatment effects. Our findings demonstrate that active drug users with dual diagnoses are able to participate in conventional treatment.
Stein
Michael D
MD
Department of Medicine, Brown University School of Medicine, Providence, RI 02903, USA. mstein@lifespan.org
Solomon
David A
DA
Herman
Debra S
DS
Anthony
Jennifer L
JL
Ramsey
Susan E
SE
Anderson
Bradley J
BJ
Miller
Ivan W
IW
D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy; D015819:Substance Abuse, Intravenous / Q000523:psychology*; D016896:Treatment Outcome
D014150:Antipsychotic Agents