Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Department of Mathematics, University of Texas at Arlington, Arlington, TX, USA.
J Affect Disord. 2023 Oct 15;339:691-697. doi: 10.1016/j.jad.2023.07.049. Epub 2023 Jul 17.
Guidance on Major Depressive Disorder (MDD) treatment in those with comorbid Alcohol Use Disorder (AUD) is limited. We performed a secondary analysis on the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, examining the association between comorbid AUD and depression outcomes.
STARD was a real-world effectiveness trial starting with citalopram in level 1. Non-responding participants progressed through 3 other sequential treatment levels with different switch or augmentation options. Antidepressant outcomes were compared between MDD (n = 2826) and comorbid MDD and AUD (n = 864). Logistic regressions were performed to evaluate remission and response predictors in the total STARD sample and the AUD-comorbidity interaction.
Chi-squared tests showed no significant difference in response or remission rates from depression between groups across treatment levels. Higher Hamilton Rating Scale for Depression (HRSD) score was associated with overall lower odds of remission in treatment level 1 (OR = 0.93, p < 0.001) and 2 (OR = 0.95, p < 0.001), with no significant interaction with comorbid AUD. Higher baseline suicidality had overall lower odds of remission in level 1 (OR = 0.82, p < 0.001) and 2 (OR = 0.1, p < 0.001), but with comorbid AUD compared to no AUD, suicidality increased odds of level 1 remission (OR = 1.30, p = 0.012). In comorbid AUD in level 2, venlafaxine was associated with lower odds of remission (OR = 0.13, p = 0.013) and response (OR = 0.12, p = 0.006); bupropion with lower odds of response (OR = 0.22, p = 0.024).
Open label study design and lack of alcohol use data.
Comorbid AUD may interact with predictors of antidepressant response in MDD and using venlafaxine or bupropion may be less effective. Addressing this comorbidity requires unique assessment and treatment approaches.
针对同时患有酒精使用障碍（AUD）的重度抑郁症（MDD）患者的治疗指导有限。我们对序贯治疗选择缓解抑郁（STAR*D）研究进行了二次分析，研究了共病 AUD 与抑郁结局之间的关联。
STARD 是一项真实世界的有效性试验，从水平 1 的西酞普兰开始。未应答的参与者通过其他 3 个不同的治疗级别进行治疗，每个级别都有不同的转换或增效选择。在 MDD（n=2826）和共病 MDD 和 AUD（n=864）患者中比较抗抑郁药的治疗结果。进行逻辑回归以评估总 STARD 样本和 AUD 共病的交互作用中的缓解和反应预测因素。
卡方检验显示，在整个治疗过程中，两组之间的反应率或缓解率没有显著差异。汉密尔顿抑郁量表（HRSD）评分越高，1 级治疗的缓解总体可能性越低（OR=0.93，p<0.001）和 2 级（OR=0.95，p<0.001），与共病 AUD 无显著交互作用。基线自杀意念越高，1 级（OR=0.82，p<0.001）和 2 级（OR=0.1，p<0.001）的缓解总体可能性越低，但与共病 AUD 相比，无 AUD 患者自杀意念增加了缓解的可能性（OR=1.30，p=0.012）。在共病 AUD 的 2 级治疗中，文拉法辛与较低的缓解率（OR=0.13，p=0.013）和反应率（OR=0.12，p=0.006）相关；安非他酮与较低的反应率（OR=0.22，p=0.024）相关。
开放标签的研究设计和缺乏酒精使用数据。
共病 AUD 可能与 MDD 抗抑郁反应的预测因素相互作用，使用文拉法辛或安非他酮可能效果不佳。解决这种共病需要独特的评估和治疗方法。
