title: Effect of concurrent substance use disorder on the effectiveness of single and combination antidepressant medications for the treatment of major depression: an exploratory analysis of a single-blind randomized trial.
abstract: BACKGROUND
  The co-occurrence of substance use disorder (SUD) and major depressive disorder (MDD) is common and is often thought to impair response to antidepressant therapy. These patients are often excluded from clinical trials, resulting in a significant knowledge gap regarding optimal pharmacotherapy for the treatment of MDD with concurrent SUD.
  
  
  METHODS
  In the Combining Medications to Enhance Depression Outcomes study, 665 adult outpatients with chronic and/or recurrent MDD were prospectively treated with either escitalopram monotherapy (escitalopram and placebo) or an antidepressant combination (venalfaxine-XR and mirtazapine or escitalopram and bupropion-SR). Participants with MDD and concurrent SUD (13.1%) were compared to those without SUD (86.9%) on sociodemographic and clinical characteristics at baseline and treatment response at 12- and 28-week endpoints.
  
  
  RESULTS
  The participants with MDD and SUD were more likely to be male and have current suicidal thoughts/plans, and had a greater lifetime severity and number of suicide attempts, and a higher number of concurrent Axis I disorders, particularly concurrent anxiety disorders. There were no significant differences between the MDD with or without SUD groups in terms of dose, time in treatment, response or remission at week 12 and 28. Furthermore, no significant differences in response or remission rates were noted between groups on the basis of the presence or absence of SUD and treatment assignment.
  
  
  CONCLUSIONS
  Although significant baseline sociodemographic and clinical differences exist, patients with MDD and concurrent SUD are as likely to respond and remit to a single or combination antidepressant treatment as those presenting without SUD.
authors.affiliation: VA Medical Center, Tuscaloosa, Alabama 35404, United States. lori.davis@med.va.gov
authors.forename: Lori L
authors.initials: LL
authors.lastname: Davis
authors.forename: Patricia
authors.initials: P
authors.lastname: Pilkinton
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Gaynes
authors.forename: Robert H
authors.initials: RH
authors.lastname: Howland
authors.forename: Sidney
authors.initials: S
authors.lastname: Zisook
authors.forename: G K
authors.initials: GK
authors.lastname: Balasubramani
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000008:administration & dosage*; D016642:Bupropion / Q000008:administration & dosage; D002908:Chronic Disease; D015283:Citalopram / Q000008:administration & dosage; D003511:Cyclohexanols / Q000008:administration & dosage; D003865:Major Depressive Disorder / Q000188:drug therapy*; D017831:Diagnosis, Dual (Psychiatry); D004359:Drug Therapy, Combination; D006801:Humans; D008803:Mianserin / Q000008:administration & dosage / Q000031:analogs & derivatives; D000078785:Mirtazapine; D012008:Recurrence; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000188:drug therapy*; D013406:Suicide, Attempted; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D003511:Cyclohexanols; D016642:Bupropion; D015283:Citalopram; D008803:Mianserin; D000069470:Venlafaxine Hydrochloride; D000078785:Mirtazapine