[Depression and addictions: links and therapeutic sequence]

Area of Science:

• Psychiatry
• Addiction Medicine
• Clinical Psychology

Context:

• Substance use disorders (SUDs) and major depression (MD) are highly comorbid.
• This co-occurrence affects 25-50% of individuals with addiction and is prevalent in the general population.
• Comorbidity negatively impacts the prognosis of both disorders, particularly increasing suicide risk.

Purpose:

• To explore the relationship between substance use disorders and major depression.
• To outline the influence of substance use on depression presentation and vice versa.
• To provide treatment guidelines for comorbid depression and SUDs.

Summary:

• The relationship between MD and SUDs is complex, with potential causal links including self-medication, independent co-occurrence, or substance-induced mood disorders.
• Depression presentation can be complicated by substance consumption or withdrawal.
• Treatment for depression in individuals with SUDs involves careful timing of antidepressant medication, typically after initial withdrawal, with a 15-day monitoring period for mood improvement.

Impact:

• Effective management of this comorbidity is crucial for improving patient outcomes and reducing suicide rates.
• Dual diagnosis units, integrating psychiatric and addiction expertise, are recommended for optimal care.
• Understanding the interplay between depression and substance use informs clinical practice and treatment strategies.