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Substance use disorders and risk for treatment resistant depression: a population-based, nested case-control study
Philip Brenner1, Lena Brandt1, Gang Li2
1Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Addiction (Abingdon, England)
|October 28, 2019
Summary
Patients with recent or current substance use disorders (SUD) face nearly double the risk of treatment-resistant depression (TRD) when starting antidepressant treatment. This highlights the critical need to address SUD in depression management for better outcomes.
Area of Science:
- Psychiatry
- Clinical Psychology
- Pharmacology
Background:
- Treatment-resistant depression (TRD) affects many patients initiating antidepressant therapy.
- Substance use disorders (SUD) are prevalent in depressed populations and linked to poorer outcomes.
- Previous studies have not established a clear link between SUD and TRD risk.
Purpose of the Study:
- To investigate the association between substance use disorders (SUD) and treatment-resistant depression (TRD).
Main Methods:
- A nested case-control study utilizing nationwide Swedish health-care registers.
- A cohort of 121,669 antidepressant initiators with depression was established (2006-2014).
- 15,631 patients (13%) met TRD criteria (≥3 trials/episode); each case was matched with five controls.
Main Results:
- Recent or current SUD (within 180 days prior to treatment) nearly doubled TRD risk (aOR=1.86).
- Specific SUD subtypes showed increased TRD risk: sedatives (aOR=2.37), opioids (aOR=2.02), alcohol (aOR=1.77), and combined use (aOR=2.31).
Conclusions:
- Recent or current substance use disorders are positively associated with treatment resistance in depression.
- Addressing SUD is crucial for improving treatment outcomes in patients with depression.
- This study provides strong evidence for the link between SUD and TRD.
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