title: Depression in patients with alcohol use disorders: Systematic review and meta-analysis of outcomes for independent and substance-induced disorders.
abstract: BACKGROUND
  In patients with an alcohol use disorder, depression is commonly categorised as independent (ID) or substance-induced (SID). It is not established whether these conditions respond differently to treatment.
  
  
  METHODS
  MEDLINE, Embase and Cochrane databases from 1980 to 2014 were searched for studies on alcohol use disorders with coexisting depressive symptoms. Meta-analyses were conducted using random effects models, to derive pooled effect estimates of the change in depression during treatment and the effect of antidepressant therapy.
  
  
  RESULTS
  Twenty-two studies met inclusion criteria for the review, of which 11/22 were included in the meta-analysis. All studies reported a large improvement in depression symptom score, most of which occurred within the first 3-6 weeks of treatment. The amount of improvement during follow up was similar in studies on ID in comparison to those in undifferentiated depression. Evidence on the outcome for SID was limited. The effect size of antidepressant therapy compared to placebo was 0.25 (0.06, 0.44) for ID and 0.08 (-0.31, 0.47) for SID or undifferentiated depression.
  
  
  CONCLUSIONS
  Few studies examined the natural history and treatment response of SID. There was heterogeneity between studies, which was partly explained by baseline depression severity.
  
  
  CONCLUSIONS
  Treatment for depression co-occurring with an alcohol use disorder is associated with a large early improvement in depression, even if depression is believed to be independent of drinking. The effect of antidepressant therapy on depression in patients with alcohol use disorders is modest, with stronger evidence in ID.
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: 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: Biostatistics and Computational Biology, Department of Public Health and General Practise, University of Otago, Christchurch, New Zealand.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Williman
authors.affiliation: Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Roger T
authors.initials: RT
authors.lastname: Mulder
mesh_terms: D019973:Alcohol-Related Disorders / Q000150:complications* / Q000523:psychology*; D003866:Depressive Disorder / Q000150:complications* / Q000523:psychology* / Q000628:therapy; D006801:Humans; D011613:Psychotherapy
keywords: Alcohol drinking; Alcohol-induced disorder; Alcohol-related disorders; Antidepressive agents; Depression; Depressive disorder