Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.
Department of Research, Maryland Treatment Centers/Mountain Manor Treatment Center, Baltimore, Maryland, USA.
Am J Addict. 2023 May;32(3):291-300. doi: 10.1111/ajad.13371. Epub 2023 Jan 16.
To inform clinical practice, we identified subgroups of adults based on levels of depression symptomatology over time during opioid use disorder (OUD) treatment.
Participants were 474 adults in a 24-week treatment trial for OUD. Depression symptoms were measured using the 17-item Hamilton Depression Rating Scale (HAM-D) at nine-time points. This was a secondary analysis of the Clinical Trials Network Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment (XBOT) trial using a growth mixture model.
Three distinct depression trajectories were identified: Class 1 High Recurring-10% with high HAM-D with initial partial reductions (of HAM-D across time), Class 2 Persistently High-5% with persistently high HAM-D, and Class 3 Low Declining-85% of the participants, with low HAM-D with early sustained reductions. The majority (low declining) had levels of depression that improved in the first 4 weeks and then stabilized across the treatment period. In contrast, 15% (high recurring and persistently high) had high initial levels that were more variable across time. The persistently high class had higher rates of opioid relapse.
In this OUD sample, most depressive symptomatology was mild and improved after medication treatment for opioid use disorder (MOUD). Smaller subgroups had higher depressive symptoms that persisted or recurred after the initiation of MOUD. Depressive symptoms should be followed in patients initiating treatment for OUD, and when persistent, should prompt further evaluation and consideration of antidepressant treatment.
This study is the first to identify three distinct depression trajectories among a large clinical sample of individuals in MOUD treatment.
为了指导临床实践，我们根据阿片类药物使用障碍（OUD）治疗期间抑郁症状随时间的变化，确定了成年人亚组。
研究对象为参加 OUD 24 周治疗试验的 474 名成年人。抑郁症状使用汉密尔顿抑郁量表（HAM-D）的 17 项条目在 9 个时间点进行测量。这是对 XBOT 试验（Clinical Trials Network Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment）的二次分析，使用增长混合模型。
确定了三种不同的抑郁轨迹：第 1 类高复发-10%，表现为 HAM-D 高且初始部分减少（HAM-D 随时间减少）；第 2 类持续高-5%，表现为 HAM-D 持续高；第 3 类低下降-85%的参与者，HAM-D 低且早期持续减少。大多数（低下降）的抑郁水平在第 1 个月改善，然后在整个治疗期间稳定。相比之下，15%（高复发和持续高）的参与者初始水平较高，随时间波动较大。持续高类别的阿片类药物复发性更高。
在这个 OUD 样本中，大多数抑郁症状较轻，在接受阿片类药物使用障碍药物治疗（MOUD）后得到改善。较小的亚组存在更高的抑郁症状，在开始 MOUD 后持续或复发。应在开始治疗 OUD 的患者中监测抑郁症状，如果持续存在，应进一步评估并考虑使用抗抑郁治疗。
本研究首次在接受 MOUD 治疗的大量临床样本中确定了三种不同的抑郁轨迹。
