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.