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Research Summary

Do Antidepressants Improve Opioid Agonist Treatment Outcomes?

Both chronic opioid use and opioid withdrawal can induce symptoms that are difficult to distinguish from mood disorders. This 12-week randomized clinical trial sought to determine whether treatment of depressive symptoms with escitalopram during opioid agonist treatment (OAT) with buprenorphine improved treatment retention compared with placebo. A total of 147 opioid-dependent individuals with depressive symptoms were randomized to either escitalopram or placebo at study initiation and began OAT induction 5 days later. Mean age of participants was 38 years; 76% were male, and 80% were white. Fifty-six percent of participants met criteria for a major depression at baseline.

 

  • Thirty-nine percent of patients did not complete treatment (33% in the escitalopram arm and 44% in the placebo arm).
  • Mean Beck Depression Inventory scores improved throughout treatment, with greatest improvements within the first 2 weeks. Escitalopram had no effect on treatment retention, depression outcomes, or illicit drug use compared with placebo.

Comments:

These results suggest contemporaneous initiation of antidepressants and OAT does not improve retention, and depressive symptoms improve early in OAT regardless of antidepressant treatment. As stated by the authors, the decline in depressive symptoms may be related to OAT itself and the resultant improvement of psychosocial stressors. Jeanette M. Tetrault, MD

Reference:

Stein MD, Herman DS, Kettavong M, et al. Antidepressant treatment does not improve buprenorphine retention among opioid-dependent persons. J Subst Abuse Treat. 2010;39(2):157–166.

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