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Comorbid SUD Reduces Likelihood of Optimal Depression Care

November 10, 2020

Patients with depression are less likely to receive guideline-concordant outpatient depression treatment if they have co-occurring substance use disorder, researchers found in a study published online in The American Journal of Psychiatry.

“Best practices support providing individuals with depression and substance use disorders treatment for both disorders, with integrated or concurrent treatments to target both disorders simultaneously,” a Psychiatric News Alert quoted from the study. “[O]ur study … indicates a treatment gap in guideline-concordant depression treatment among those with substance use disorders compared with those without.”

The retrospective cohort study included 53,034 patients of the US Veterans Health Administration diagnosed with a depressive disorder in fiscal year 2017. Researchers investigated the provision of optimal depression treatment for patients with and without co-occurring substance use disorders.

Significant Rise in Cannabis Use Among US Adults With Depression

Guideline-concordant depression treatment, including both medication and psychotherapy, was lower across metrics for patients with co-occurring depression and substance use disorders, compared with patients without substance use disorders, according to the study.

For antidepressant treatment specifically, patients with co-occurring depression and substance use disorders had 21% lower odds of guideline-concordant acute treatment (defined as antidepressant medication for at least 84 of the 114 days following an initial prescription) and 26% lower odds of continuation of treatment (antidepressant medication for 180 of the 231 days following an initial prescription), researchers reported. 

For psychotherapy, patients with co-occurring depression and substance use disorders had 13% lower odds of adequate acute-phase treatment (defined as participation in a psychotherapy session for depression within 90 days of the depression diagnosis) and 19% lower odds of psychotherapy continuation (defined as participation in at least 3 psychotherapy sessions in the 12 weeks following the first therapy session). 

“Efforts to improve the provision of care to those with co-occurring substance use disorders should focus on clinician-based interventions and use of integrated care models to improve the quality of depression treatment,” researchers advised.

—Jolynn Tumolo 


Coughlin LN, Pfeiffer P, Ganoczy D, Lin LA. Quality of outpatient depression treatment in patients with comorbid substance use disorder. The American Journal of Psychiatry. 2020 October 29;[Epub ahead of print]. 

Depression care suboptimal for patients with comorbid substance use disorders, study finds. Psychiatric News Alert. October 29, 2020.

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