[Depression and addictions: links and therapeutic sequence]

Substance use disorders and major depression are currently associated in clinical population where depression criteria have concerned twenty-five to fifty percent of addict people. The co-occurrence is also showed widespread among the general population for all kind of substance, alcohol and illicit drugs. This comorbidity has pejorative influence on prognosis for each disorder, with particular acuteness on suicide. Furthermore, presentation of major depression is often complicated by consumption or withdrawal. Clinical studies and general population surveys help to describe nature of the causal relationship with three main explanations: self-medication of mood disorders, independent co-occurrence, and substance-induced depressive disorders. Guidelines for treatment of depression on addict people are: no antidepressant medication before complete withdrawal, improvement of mood in the first two weeks of abstinence, indication to treat depression if no improvement after fifteen days. Dual diagnosis units offering psychiatric and addiction competencies could be relevant for this particular comorbidity.