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Substance use disorders and risk for treatment resistant depression: a population‐based, nested case‐control study.

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Title: Substance use disorders and risk for treatment resistant depression: a population‐based, nested case‐control study.
Authors: Brenner, Philip (AUTHOR), Brandt, Lena (AUTHOR), Li, Gang (AUTHOR), DiBernardo, Allitia (AUTHOR), Bodén, Robert (AUTHOR), Reutfors, Johan (AUTHOR)
Source: Addiction. Apr2020, Vol. 115 Issue 4, p768-777. 10p. 4 Charts.
Subjects: Mental depression risk factors, Antidepressants, Confidence intervals, Mental depression, Alcohol drinking, Drug resistance, Narcotics, Risk assessment, Substance abuse, Socioeconomic factors, Treatment effectiveness, Case-control method, Descriptive statistics, Odds ratio, Disease complications
Geographic Terms: Sweden
Abstract: Background and aims: Treatment‐resistant depression (TRD), defined as inadequate treatment response after at least two adequate treatment trials, is common among patients initiating antidepressant treatment. Current or previous substance use disorders (SUD) are common among patients with depression and often lead to worse treatment outcomes. However, in clinical studies, SUD have not been found to increase the risk for TRD. The aim of this study was to investigate the association between SUD and TRD. Design Nested case–control study. Setting: Nation‐wide governmental health‐care registers in Sweden. Cases and controls: Data on prescribed drugs and diagnoses from specialized health care were used to establish a prospectively followed cohort of antidepressant initiators with depression (n = 121 669) from 2006 to 2014. Of these, 15 631 patients (13%) were defined as TRD cases, with at least three treatment trials within a single depressive episode. Each case with TRD was matched on socio‐demographic data with five controls with depression. Measurements Crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI) estimated the association between TRD and SUD diagnosis and/or treatment in five different time intervals until the time for fulfillment of TRD definition for the case. The analysis was adjusted for clinical and socio‐demographic covariates. Findings Having any SUD during, or ≤ 180 days before start of, antidepressant treatment was associated with almost double the risk for TRD [≤ 180 days before: adjusted OR (aOR) = 1.86, CI = 1.70–2.05]. Increased risks for TRD were found ≤ 180 days before treatment start for the subcategories of sedative use (aOR = 2.37; 1.88–2.99), opioids (aOR = 2.02; 1.48–2.75), alcohol (aOR = 1.77; CI = 1.59–1.98) and combined substance use (aOR = 2.31; 1.87–2.99). Conclusions: Recent or current substance use disorders is positively associated with treatment resistance among patients initiating treatment for depression. [ABSTRACT FROM AUTHOR]
Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Substance use disorders and risk for treatment resistant depression: a population‐based, nested case‐control study.
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  Data: <searchLink fieldCode="AR" term="%22Brenner%2C+Philip%22">Brenner, Philip</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Brandt%2C+Lena%22">Brandt, Lena</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Li%2C+Gang%22">Li, Gang</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22DiBernardo%2C+Allitia%22">DiBernardo, Allitia</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Bodén%2C+Robert%22">Bodén, Robert</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Reutfors%2C+Johan%22">Reutfors, Johan</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Addiction%22">Addiction</searchLink>. Apr2020, Vol. 115 Issue 4, p768-777. 10p. 4 Charts.
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  Data: <searchLink fieldCode="DE" term="%22Mental+depression+risk+factors%22">Mental depression risk factors</searchLink><br /><searchLink fieldCode="DE" term="%22Antidepressants%22">Antidepressants</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+depression%22">Mental depression</searchLink><br /><searchLink fieldCode="DE" term="%22Alcohol+drinking%22">Alcohol drinking</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+resistance%22">Drug resistance</searchLink><br /><searchLink fieldCode="DE" term="%22Narcotics%22">Narcotics</searchLink><br /><searchLink fieldCode="DE" term="%22Risk+assessment%22">Risk assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Substance+abuse%22">Substance abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Socioeconomic+factors%22">Socioeconomic factors</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Case-control+method%22">Case-control method</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Odds+ratio%22">Odds ratio</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+complications%22">Disease complications</searchLink>
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  Data: Background and aims: Treatment‐resistant depression (TRD), defined as inadequate treatment response after at least two adequate treatment trials, is common among patients initiating antidepressant treatment. Current or previous substance use disorders (SUD) are common among patients with depression and often lead to worse treatment outcomes. However, in clinical studies, SUD have not been found to increase the risk for TRD. The aim of this study was to investigate the association between SUD and TRD. Design Nested case–control study. Setting: Nation‐wide governmental health‐care registers in Sweden. Cases and controls: Data on prescribed drugs and diagnoses from specialized health care were used to establish a prospectively followed cohort of antidepressant initiators with depression (n = 121 669) from 2006 to 2014. Of these, 15 631 patients (13%) were defined as TRD cases, with at least three treatment trials within a single depressive episode. Each case with TRD was matched on socio‐demographic data with five controls with depression. Measurements Crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI) estimated the association between TRD and SUD diagnosis and/or treatment in five different time intervals until the time for fulfillment of TRD definition for the case. The analysis was adjusted for clinical and socio‐demographic covariates. Findings Having any SUD during, or ≤ 180 days before start of, antidepressant treatment was associated with almost double the risk for TRD [≤ 180 days before: adjusted OR (aOR) = 1.86, CI = 1.70–2.05]. Increased risks for TRD were found ≤ 180 days before treatment start for the subcategories of sedative use (aOR = 2.37; 1.88–2.99), opioids (aOR = 2.02; 1.48–2.75), alcohol (aOR = 1.77; CI = 1.59–1.98) and combined substance use (aOR = 2.31; 1.87–2.99). Conclusions: Recent or current substance use disorders is positively associated with treatment resistance among patients initiating treatment for depression. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Addiction is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/add.14866
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        Text: English
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        PageCount: 10
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    Subjects:
      – SubjectFull: Mental depression risk factors
        Type: general
      – SubjectFull: Antidepressants
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      – SubjectFull: Confidence intervals
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      – SubjectFull: Alcohol drinking
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