Evaluation and treatment of mood and anxiety disorders in opioid-dependent patients

Mood and anxiety disorders are common and treatable but may cause considerable morbidity if left untreated. This is especially so in opioid-dependent individuals, for whom diagnosis is difficult and rehabilitation easily compromised. Clinicians need guidelines to distinguish the patient with an independent mood or anxiety disorder from the more common anxious or depressed addict who is withdrawing, intoxicated or reacting to a life crisis. This article reviews the current knowledge of diagnosis, clinical presentation, and prevalence of mood and anxiety disorders common among opioid-dependent patients. It attempts to identify features of a patient's history that distinguish truly independent disorders and proceeds to a discussion of treatment approaches for this subgroup.