title: Depression outcome in alcohol dependent patients: an evaluation of the role of independent and substance-induced depression and other predictors.
abstract: BACKGROUND
  Depression commonly co-occurs with alcohol use disorders but predictors of depression treatment outcome in patients with both conditions are not well established.
  
  
  METHODS
  Outpatients with alcohol dependence and major depression (n=138) were prescribed naltrexone and randomized to citalopram or placebo for 12 weeks, followed by a 12-week naturalistic outcome phase. General linear mixed models examined predictors of Montgomery Asberg Depression Rating Scale (MADRS) score over 24 weeks. Predictors included whether depression was independent or substance-induced, and demographic, alcohol use, and personality variables (Temperament and Character Inventory subscales).
  
  
  RESULTS
  Most improvement in drinking and depression occurred between baseline and week 3. During follow-up, patients with substance-induced depression reduced their drinking more and they had better depression outcomes than those with independent depression. However, greater reduction in drinking was associated with better depression outcomes for both independent and substance-induced groups, while antidepressant therapy had no effect for either group. Baseline demographic and alcohol use variables did not predict depression outcomes. Among personality variables, high self-directedness was a strong predictor of better depression outcomes.
  
  
  CONCLUSIONS
  Subjects were not abstinent at baseline. The influence of naltrexone on depression outcomes could not be tested.
  
  
  CONCLUSIONS
  Alcohol dependent patients with substance-induced depression have better short term depression outcomes than those with independent depression, but this is largely because they reduce their drinking more during treatment.
authors.affiliation: Department of Psychological Medicine, University of Otago, Christchurch, New Zealand. Electronic address: james.foulds@otago.ac.nz.
authors.forename: James A
authors.initials: JA
authors.lastname: Foulds
authors.affiliation: Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: J
authors.initials: J
authors.lastname: Douglas Sellman
authors.affiliation: Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Adamson
authors.affiliation: Christchurch Health and Development Study, University of Otago, Christchurch, New Zealand.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Boden
authors.affiliation: Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Roger T
authors.initials: RT
authors.lastname: Mulder
authors.affiliation: Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Joyce
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications*; D015283:Citalopram / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000139:chemically induced / Q000150:complications* / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use*; D010555:Personality Inventory; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015283:Citalopram; D009271:Naltrexone
keywords: Alcohol-induced disorder; Alcohol-related disorders; Comorbidity; Depression; Depressive disorder; Treatment outcome