title: Effects of independent and substance-induced major depressive disorder on remission and relapse of alcohol, cocaine and heroin dependence.
abstract: OBJECTIVE
  Little is known about the differential effects of independent and substance-induced major depression on the longitudinal course of alcohol, cocaine and heroin disorders when studied prospectively.
  
  
  METHODS
  Consecutively admitted in-patients, evaluated at baseline, 6-, 12- and 18-month follow-ups.
  
  
  METHODS
  Baseline evaluations in a short-stay in-patient urban community psychiatric hospital unit.
  
  
  METHODS
  Adults (n = 250) with current DSM-IV cocaine, heroin and/or alcohol dependence at baseline.
  
  
  METHODS
  The Psychiatric Research Interview for Substance and Mental Disorders (PRISM), used to evaluate independent and substance-induced major depression, alcohol, cocaine and heroin dependence, and other psychiatric disorders. Outcomes for each substance: (i) time (weeks) from hospital discharge to first use; (ii) time from discharge to onset of sustained (≥26 weeks) remission from dependence; (iii) time from onset of sustained remission to relapse.
  
  
  RESULTS
  Substance-induced major depression significantly predicted post-discharge use of alcohol, cocaine and heroin (hazard ratios 4.7, 5.3 and 6.5, respectively). Among patients achieving stable remissions from dependence, independent major depression predicted relapse to alcohol and cocaine dependence (hazard ratios 2.3 and 2.7, respectively).
  
  
  CONCLUSIONS
  Substance-induced and independent major depressions were both related to post-discharge use of alcohol, cocaine and heroin. The findings suggest the importance of clinical attention to both types of depression in substance abusing patients.
authors: School of Social Work, Columbia University, New York, NY, USA.
authors: Sharon
authors: S
authors: Samet
authors: Miriam C
authors: MC
authors: Fenton
authors: Edward
authors: E
authors: Nunes
authors: Eliana
authors: E
authors: Greenstein
authors: Efrat
authors: E
authors: Aharonovich
authors: Deborah
authors: D
authors: Hasin
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology* / Q000628:therapy; D019970:Cocaine-Related Disorders / Q000523:psychology* / Q000628:therapy; D003865:Major Depressive Disorder / Q000209:etiology*; D005260:Female; D006556:Heroin Dependence / Q000523:psychology* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors