Effects of major depression on remission and relapse of substance dependence
Effects of major depression on remission and relapse of substance dependence
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DOI：
10.1001/archpsyc.59.4.375
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发表时间：
2002-04-01
影响因子：
--
通讯作者：
Endicott, J
中科院分区：
文献类型：
--
作者：
Hasin, D;Liu, XH;Endicott, J
背景：重度抑郁症（MDD）对物质依赖病程的影响可能因抑郁症与依赖的时间关系而异。我们在3种情况下研究了MDD对物质依赖结果的影响：（1）一生之中抑郁症发病先于依赖发病；（2）在戒断期间出现当前抑郁症；（3）在物质使用期间出现当前抑郁症，且其影响超过中毒或戒断的预期影响。
方法：对250名符合《精神疾病诊断与统计手册》第四版（DSM - IV）中可卡因、海洛因和/或酒精依赖诊断标准的住院患者进行为期6个月、12个月和18个月的随访。采用物质与精神障碍心理研究访谈（PRISM）进行DSM - IV诊断。利用考克斯比例风险模型，研究了符合DSM - IV标准的可卡因、海洛因和/或酒精依赖及使用情况的稳定缓解（持续至少26周），以及随后的依赖和使用复发情况。
结果：与无基线MDD的患者相比，当前患有物质诱导的MDD的患者从依赖中缓解的可能性更小（调整后的风险比为0.11）。在一生之中物质依赖发病前有MDD病史的患者，相对于无此病史的患者，缓解的可能性也降低（调整后的风险比为0.49）。与无戒断期MDD的患者相比，持续戒断期间的重度抑郁症预示着依赖复发（调整后的风险比为3.07）以及出院后的物质使用（调整后的风险比为1.45）。
结论：抑郁发作相对于物质依赖的时间是物质依赖和物质使用缓解及复发的一个重要因素。
Background: The effects of major depressive disorder (MDD) on the course of substance dependence may differ depending on the temporal relationship of depression to dependence. We investigated the effects of MDD on the outcome of substance dependence under 3 circumstances: (1) lifetime onset of MDD prior to lifetime onset of dependence onset, (2) current MDD occurring during a period of abstinence, and (3) current MDD during substance use that exceeded the expected effects of intoxication or withdrawal.Methods: A sample of 250 inpatients with DSM-IV cocaine, heroin, and/or alcohol dependence were followed up at 6, 12, and 18 months. The Psychiatric Research Interview for Substance and Mental Disorders (PRISM) was used to make DSM-IV diagnoses. Using Cox proportional hazards models, stable remissions (those lasting at least 26 weeks) from DSM-IV cocaine, heroin, and/or alcohol dependence and from use were studied, as well as subsequent relapses of dependence and use.Results: Patients with current substance-induced MDD were less likely to remit from dependence (adjusted hazards ratio, 0.11) than patients with no baseline MDD. A history of MDD prior to lifetime onset of substance dependence also reduced the likelihood of remission relative to the absence of such a history (adjusted hazard ratio, 0.49). Major depressive disorder during sustained abstinence predicted dependence relapse (adjusted hazards ratio, 3.07) and substance use after hospital discharge compared with those without abstinence MDD (adjusted hazards ratio, 1.45).Conclusion: The timing of depressive episodes relative to substance dependence served as an important factor in the remission and relapse of substance dependence and substance use.