Depressive disorders are common among opiate abusers and are associated
with detrimental behavioral effects. However, there is little precedent for
offering active drug users complex treatments for depression.
To determine whether combined psychotherapy and pharmacotherapy treatment
reduces reported depressive symptoms compared with an assessment-only condition
among out-of-treatment drug injectors.
Randomized controlled trial.
Research office located at an academic medical center.
Active injection drug users with a DSM-IV diagnosis
of major depression, dysthymia, substance-induced mood disorder with symptoms
persisting for at least 3 months, or major depression plus dysthymia, and
a Modified Hamilton Rating Scale for Depression (HAM-D) score greater than
Combined psychotherapy (8 sessions of cognitive behavior therapy) plus
Main Outcome Measures
Modified HAM-D scale scores at the end of 3 months of combined treatment.
The 109 study subjects were 64% male and had a mean age of 36.7 years
and a mean baseline HAM-D score of 20.7. Depression subtypes included major
depression only (63%), substance-induced depression (17%), and major depression
plus dysthymia (17%). In the intent-to-treat analysis, participants in treatment
averaged 2.11 HAM-D points greater improvement than control subjects (P = .08), and 26.1% of combined treatment patients (n =
53) compared with 12.5% of control patients (n = 56) were in remission (P = .047). Nearly 40% of fully adherent subjects (receiving
>75% of either psychotherapy or pharmacotherapy) were in remission at follow-up
(odds ratio, 3.6; P = .04).
Combined treatment for depression is significantly superior to a control
condition (assessment only) in proportion of patients in remission, but not
in HAM-D improvement among drug injectors. Full adherence to treatment is
associated with the largest treatment effects. Our findings demonstrate that
active drug users with dual diagnoses are able to participate in conventional