title: Antidepressant treatment does not improve buprenorphine retention among opioid-dependent persons.
abstract: Our goal was to determine whether treatment of depressive symptoms with escitalopram during buprenorphine treatment for opioid dependence would improve treatment retention compared to placebo in a 12-week, randomized, double-blind trial. Treatment dropout was defined as missing seven consecutive buprenorphine dosing days. Participants were 76% male, 80% non-Hispanic Caucasian, and 64% heroin users. At baseline, the mean Beck Depression Inventory II (BDI-II) score was 28.4 (+/-9.7). Sixty-one percent of participants completed the 12-week buprenorphine protocol. Dropout rates were 33.3% and 44.0% among those randomized to escitalopram or placebo, respectively (p = .19). Relative to baseline, mean BDI-II scores were significantly lower at all follow-up assessments, but the Treatment x Time interaction effect was not statistically significant (p = .18). Participants randomized to escitalopram also did not have a significantly lower likelihood of testing positive for either opiates or other drugs during follow-up. Depressive symptoms often resolved with buprenorphine treatment, and the immediate initiation of escitalopram does not improve treatment retention, depression outcomes, or illicit drug use. Clinicians should determine the need for antidepressant treatment later in buprenorphine care.
authors.affiliation: Brown University, Butler Hospital, General Medicine Research, Providence, RI 02906, USA. michael_stein@brown.edu
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stein
authors.forename: Debra S
authors.initials: DS
authors.lastname: Herman
authors.forename: Malyna
authors.initials: M
authors.lastname: Kettavong
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cioe
authors.forename: Peter D
authors.initials: PD
authors.lastname: Friedmann
authors.forename: Tahir
authors.initials: T
authors.lastname: Tellioglu
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D015283:Citalopram / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000523:psychology
chemical_list: D000928:Antidepressive Agents; D009292:Narcotic Antagonists; D015283:Citalopram; D002047:Buprenorphine