Independent Versus Substance-Induced Major Depressive Disorder in Substance-Dependent Patients: Observational Study of Course During Follow-Up
J Clin Psychiatry 2006;67(10):1561-1567
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Objective: Clinicians frequently
encounter patients presenting with both depression and
substance abuse, and their diagnosis has been a source of controversy. The authors
examined whether baseline and past diagnoses of
DSM-IV primary (independent) or substance-induced
depression or other psychiatric syndromes predict
1-year course of depression in substance-dependent patients.
Method: Inpatients with current DSM-IV
major depressive disorder (MDD) and DSM-IV alcohol, cocaine, or opiate dependence (N =
110) were evaluated with the Psychiatric Research
Interview for Substance and Mental Disorders (PRISM) and followed for 12 months after
discharge. Logistic regression for repeated
measures modeled the odds of MDD and depressed
mood over time as a function of baseline diagnoses
and past independent depression, controlling for
demographics, substance use, and antidepressant treatment during the follow-up. Subject
recruitment was conducted from July 25, 1995 to
May 14, 1997.
Results: Over the 12 months, 88% of the
patients experienced depressed mood for at least 1 week, and 57% experienced MDD.
Depression during follow-up was equally likely among
patients with current (baseline) DSM-IV independent or substance-induced MDD; in the
latter group, past independent MDD increased the
likelihood of MDD during the follow-up. Panic attacks, posttraumatic stress disorder (trend),
borderline personality, and antisocial personality
also significantly predicted depression during the
Conclusions: In substance-dependent
patients, both DSM-IV primary and
substance-induced MDD predict future depression, warranting
consideration for specific treatment. The data
suggest the importance of a careful psychiatric
history that includes attention to past episodes of
independent depression as well as anxiety and
cluster B personality syndromes.