title: Agitated depression in substance dependence.
abstract: BACKGROUND
  Depression with psychomotor agitation (PMA; "agitated depression") is a putative psychiatric phenotype that appears to associate with some forms of substance dependence. However, it is unclear whether such relationships extend across different substances and independent (I-MDE) versus substance-induced (SI-MDE) subtypes of major depressive episodes.
  
  
  METHODS
  We examined whether lifetime depression with (vs. without) PMA was associated with lifetime substance dependence across individuals with lifetime: (1) I-MDE only (n=575); and (2) SI-MDE only (n=1683). Data were pooled from several family and genetic studies of substance dependence in which participants received identical structured interviews to diagnose DSM-IV mental disorders.
  
  
  RESULTS
  In I-MDE, PMA was significantly associated with alcohol, cocaine, opioid, other drug (hallucinogen, inhalant, speed-ball), and sedative dependence. After controlling for demographic and clinical co-factors, PMA's relationship to dependence on opioids, other drugs, and sedatives remained significant, but not its relationship to alcohol or cocaine. In SI-MDE, PMA was significantly associated with alcohol, cocaine, opioid, and other drug dependence. After adjusting for co-factors, associations remained significant for dependence on cocaine and opioids, but not alcohol or other drugs. Relationships between PMA and opioid dependence were stronger in I-MDE than SI-MDE. Depression subtype (I-MDE vs. SI-MDE) did not moderate relations between PMA and non-opioid forms of substance dependence.
  
  
  CONCLUSIONS
  Agitated depression associates with certain forms of substance dependence, particularly opioid dependence. MDE subtype did not alter most PMA-dependence associations, which suggests that the mechanisms underlying this comorbidity are complex and potentially bidirectional.
authors.affiliation: Departments of Preventive Medicine and Psychology, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Leventhal
authors.forename: Joel
authors.initials: J
authors.lastname: Gelernter
authors.forename: David
authors.initials: D
authors.lastname: Oslin
authors.forename: Raymond F
authors.initials: RF
authors.lastname: Anton
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Farrer
authors.forename: Henry R
authors.initials: HR
authors.lastname: Kranzler
mesh_terms: D000328:Adult; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000150:complications / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011595:Psychomotor Agitation / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology* / Q000523:psychology