Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, MSC 861, 67 President Street, Charleston, SC, 29425-8610, USA.
Department of Public Health Sciences, Medical University of South Carolina, MSC 861, 67 President Street, Charleston, SC, 29425-8610, USA.
Psychopharmacology (Berl). 2020 Feb;237(2):479-490. doi: 10.1007/s00213-019-05384-z. Epub 2019 Nov 11.
Depression is common among individuals with cannabis use disorder (CUD), particularly individuals who present to CUD treatment. Treatments that consider this comorbidity are essential.
The goal of this secondary analysis was to examine whether N-acetylcysteine (NAC) reduced depressive symptoms among adults (age 18-50) with CUD (N = 302) and whether the effect of NAC on cannabis cessation varied as a result of baseline levels of depression. Bidirectional associations between cannabis use amount and depression were also examined.
Data for this secondary analysis were from a National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) multi-site clinical trial for CUD. Adults with CUD (N = 302) were randomized to receive 2400 mg of NAC daily or matched placebo for 12 weeks. All participants received abstinence-based contingency management. Cannabis quantity was measured by self-report, and weekly urinary cannabinoid levels (11-nor-9-carboxy-Δ9-tetrahydrocannabinol) confirmed abstinence. Depressive symptoms were measured by the Hospital Anxiety and Depression Scale.
Depressive symptoms did not differ between the NAC and placebo groups during treatment. There was no significant interaction between treatment and baseline depression predicting cannabis abstinence during treatment. Higher baseline depression was associated with decreased abstinence throughout treatment and a significant gender interaction suggested that this may be particularly true for females. Cross-lagged panel models suggested that depressive symptoms preceded increased cannabis use amounts (in grams) during the subsequent month. The reverse pathway was not significant (i.e., greater cannabis use preceding depressive symptoms).
Results from this study suggest that depression may be a risk factor for poor CUD treatment outcome and therefore should be addressed in the context of treatment. However, results do not support the use of NAC to concurrently treat co-occurring depressive symptoms and CUD in adults.
Clinicaltrials.gov: NCT01675661.
抑郁症在患有大麻使用障碍（CUD）的个体中很常见，尤其是那些出现 CUD 治疗的个体。考虑到这种合并症的治疗方法是必不可少的。
本二次分析的目的是检查 N-乙酰半胱氨酸（NAC）是否能降低患有 CUD 的成年人（18-50 岁）的抑郁症状（N=302），以及 NAC 对大麻戒断的影响是否因基线抑郁水平而有所不同。还检查了大麻使用量与抑郁之间的双向关联。
本二次分析的数据来自国家药物滥用治疗临床试验网络（NIDA CTN）的 CUD 多地点临床试验。患有 CUD 的成年人（N=302）被随机分配接受每日 2400 毫克 NAC 或匹配的安慰剂治疗 12 周。所有参与者都接受了基于禁欲的应急管理。大麻的用量通过自我报告来衡量，每周尿中大麻素水平（11-去甲-9-羧基-Δ9-四氢大麻酚）证实了禁欲。抑郁症状通过医院焦虑和抑郁量表来衡量。
治疗期间，NAC 组和安慰剂组的抑郁症状没有差异。治疗和基线抑郁预测治疗期间大麻戒断的交互作用不显著。较高的基线抑郁与整个治疗期间的戒断率降低有关，并且性别交互作用表明，这对女性来说可能尤其如此。交叉滞后面板模型表明，抑郁症状先于随后一个月内大麻使用量（克）的增加。相反的途径并不显著（即，大麻使用量的增加先于抑郁症状）。
这项研究的结果表明，抑郁可能是 CUD 治疗效果不佳的一个风险因素，因此应该在治疗中加以解决。然而，结果并不支持使用 NAC 同时治疗成年人同时存在的抑郁症状和 CUD。
Clinicaltrials.gov：NCT01675661。
