Patients with co-occurring depression and substance use disorders may be less likely to receive optimal depression treatment than those with depression alone, according to a study published today in AJP in Advance.
“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,” wrote Lara N. Coughlin, Ph.D., of the University of Michigan and colleagues. “[O]ur study … indicates a treatment gap in guideline-concordant depression treatment among those with substance use disorders compared with those without.”
Coughlin and colleagues analyzed data from patients who had received care from the U.S. Veterans Health Administration. Specifically, they focused on veterans diagnosed with a new episode of depression during fiscal year 2017. Patients were categorized as having a comorbid substance use disorder if they had received a substance use disorder diagnosis during the year prior to the depression diagnosis.
Patients who received an antidepressant prescription within 90 days of the depression diagnosis that provided antidepressant medication for at least 84 of the 114 days following the initial prescription were considered by the authors to have received “adequate acute-phase” medication treatment. Those who continued antidepressant medication for 180 of the first 231 days following the initial prescription were considered to have received “adequate continuation-phase” medication treatment. Similarly, the authors examined whether the patients had participated in a psychotherapy session for depression that occurred within 90 days of the index depression diagnosis (acute-phase treatment) and at least three psychotherapy sessions occurring in the 12 weeks following the first therapy session (continuation-phase treatment).
Of the 53,034 patients diagnosed with a new episode of depression during fiscal year 2017, 28,081 (52.9%) of these patients received any antidepressant treatment, and 18,484 (34.9%) received any psychotherapy for depression within 90 days following their diagnosis. Of this cohort, 7,516 (14.2%) had a substance use disorder diagnosis in the year before the depressive disorder diagnosis.
After taking patient demographic and clinical characteristics of the study participants into account, the authors found that “patients with substance use disorders had lower odds of adequate acute-phase treatment (21% and 13% lower for antidepressant and psychotherapy, respectively) and lower odds of adequate continuation of treatment (26% and 19% lower for antidepressant and psychotherapy, respectively) for depression” compared with patients with no substance use disorders.
“Although the magnitude of difference (approximately 20% lower odds) may seem modest, both depression and substance use disorders are highly prevalent, such that even modest differences amount to large numbers of individuals,” they added.
Coughlin and colleagues offered several recommendations to increase optimal depression treatment of patients with co-occurring depression and substance use disorders, including additional training for health care professionals and enhancing integrated care.
For related information, see the Psychiatric Services article “Association Between Quality Measures and Perceptions of Care Among Patients With Substance Use Disorders.”
(Image: iStock/SDI Productions)
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