Clinical practice guideline on pharmacological and psychological management of adult patients with depression and a comorbid substance use disorder
Por:
Torrens, M, Tirado-Munoz, J, Fonseca, F, Farre, M, Gonzalez-Pinto, A, Arrojo, M, Bernardo, M, Arranz, B, Garriga, M, Saiz, PA, Florez, G, Goikolea, JM, Zorrilla, I, Cunill, R, Castells, X, Becona, E, Lopez, A and San, L
Publicada:
1 ene 2022
Resumen:
Co-occurrence of depression and a substance use disorder (SUD) in patients who present dual diagnoses has been long recognized as an important consideration in clinical practice. This review synthesizes the evidence of pharmacological and psychosocial interventions for comorbid depressive disorders and SUDs while providing clinical recommendations about the best interventions to address these patients. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Our results suggest that 1) In patients with depression and alcohol consumption, the administration of non-selective serotonin reuptake inhibitor (SSRI) antidepressants instead of SSRI is recommended for improvement of depressive symptoms (strong recommendation). Neither SSRI (strong recommendation) nor non-SSRI (weak recommendation) antidepressants are recommended for reduction in alcohol consumption. 2) In patients with depression and cannabis use, the use of venlafaxine is not recommended (weak recommendation). 3) In patients with depression and cocaine consumption, the use of SSRI antidepressants for improving depressive symptoms (weak recommendation) or to reduce cocaine use is not recommended (strong recommendation). The use of non-SSRI antidepressants is only recommended for improving depressive symptoms (strong recommendation). 4) The administration of bupropion to reduce nicotine consumption is not recommended (strong recommendation). 5) Regarding psychological treatment, in patients with depression and co-occurring alcohol disorder, both pharmacotherapy and cognitive behavioural therapy have positive effects on internalizing symptoms and in reducing alcohol consumption (weak recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite evidence.
Filiaciones:
Torrens, M:
IMIM Inst Hosp del Mar Invest Med, Addict Res Grp, Barcelona, Spain
Tirado-Munoz, J:
IMIM Inst Hosp del Mar Invest Med, Addict Res Grp, Barcelona, Spain
Fonseca, F:
IMIM Inst Hosp del Mar Invest Med, Addict Res Grp, Barcelona, Spain
:
Hosp Badalona Germans Trias & Pujol, Clin Pharmacol Unit, Inst Recerca Germans Trias HUGTP IGTP, Badalona, Spain
Univ Autonoma Barcelona UAB, RTA Barcelona, Barcelona, Spain
Gonzalez-Pinto, A:
Univ Basque Country, Hosp Univ, CIBERSAM, Inst Invest Sanitaria BIOARABA,OSI Araba, Vitoria, Spain
Arrojo, M:
EOXI Santiago de Compostela, Serv Psiquiatria, Santiago De Compostela, Spain
Bernardo, M:
CIBERSAM, Inst Invest Biomed August Pi i Sunyer IDIBAPS, Hosp Clin, Barcelona, Spain
Arranz, B:
CIBERSAM, Parc Sanitari St Joan de Deu, Barcelona, Spain
Garriga, M:
CIBERSAM, Inst Invest Biomed August Pi i Sunyer IDIBAPS, Hosp Clin, Barcelona, Spain
Saiz, PA:
Univ Oviedo, CIBERSAM, Inst Invest Sanitaria Principado Asturias ISPA, Serv Salud Principado Asturias SESPA, Oviedo, Spain
Florez, G:
Complejo Hosp Ourense, Unidad Conductas Adict, CIBERSAM, Orense, Spain
Goikolea, JM:
CIBERSAM, Inst Invest Biomed August Pi i Sunyer IDIBAPS, Hosp Clin, Barcelona, Spain
Zorrilla, I:
Univ Basque Country, Hosp Univ, CIBERSAM, Inst Invest Sanitaria BIOARABA,OSI Araba, Vitoria, Spain
Cunill, R:
CIBERSAM, Parc Sanitari St Joan de Deu, Barcelona, Spain
Castells, X:
Univ Girona, Dept Ciencias Med, Grp Invest TransLab, Girona, Spain
Becona, E:
Univ Santiago de Compostela, Fac Psicol, Unidad Tabaquismo & Trastornos Adict, Santiago De Compostela, Spain
Lopez, A:
Univ Santiago de Compostela, Fac Psicol, Unidad Tabaquismo & Trastornos Adict, Santiago De Compostela, Spain
San, L:
CIBERSAM, Parc Sanitari St Joan de Deu, Barcelona, Spain
Green Published, Bronze
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