Clinical practice guideline on pharmacological and psychological management of adult patients with depression and a comorbid substance use disorder.

IF 2.2 4区 医学 Q3 SUBSTANCE ABUSE
Marta Torrens, Judit Tirado-Muñoz, Francina Fonseca, Magi Farré, Ana González-Pinto, Manuel Arrojo, Miquel Bernardo, Belén Arranz, Marina Garriga, Pilar A Sáiz, Gerardo Flórez, José Manuel Goikolea, Iñaki Zorrilla, Ruth Cunill, Xavier Castells, Elisardo Becoña, Ana López, Luis San
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引用次数: 3

Abstract

Co-occurrence of depression and a substance use disorder (SUD) in patients who present dual diagnoses has been long recognized as an important consideration in clinical practice. This review synthesizes the evidence of pharmacological and psychosocial interventions for comorbid depressive disorders and SUDs while providing clinical recommendations about the best interventions to address these patients. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Our results suggest that 1) In patients with depression and alcohol consumption, the administration of non-selective serotonin reuptake inhibitor (SSRI) antidepressants instead of SSRI is recommended for improvement of depressive symptoms (strong recommendation). Neither SSRI (strong recommendation) nor non-SSRI (weak recommendation) antidepressants are recommended for reduction in alcohol consumption. 2) In patients with depression and cannabis use, the use of venlafaxine is not recommended (weak recommendation). 3) In patients with depression and cocaine consumption, the use of SSRI antidepressants for improving depressive symptoms (weak recommendation) or to reduce cocaine use is not recommended (strong recommendation). The use of non-SSRI antidepressants is only recommended for improving depressive symptoms (strong recommendation). 4) The administration of bupropion to reduce nicotine consumption is not recommended (strong recommendation). 5) Regarding psychological treatment, in patients with depression and co-occurring alcohol disorder, both pharmacotherapy and cognitive behavioural therapy have positive effects on internalizing symptoms and in reducing alcohol consumption (weak recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite evidence.

成人抑郁症伴伴物质使用障碍的药理学和心理管理临床实践指南。
双重诊断患者抑郁症和物质使用障碍(SUD)的共同发生一直被认为是临床实践中的一个重要考虑因素。这篇综述综合了药物和社会心理干预治疗共病抑郁症和sud的证据,同时提供了针对这些患者的最佳干预措施的临床建议。来自随机对照试验的最佳证据被用于评估治疗方案。使用GRADE方法描述建议的强度。我们的研究结果表明:1)对于患有抑郁症和酗酒的患者,推荐使用非选择性5 -羟色胺再摄取抑制剂(SSRI)抗抑郁药而不是SSRI来改善抑郁症状(强烈推荐)。SSRI(强烈推荐)和非SSRI(弱推荐)抗抑郁药都不推荐用于减少酒精消费。2)抑郁症合并大麻使用的患者,不推荐使用文拉法辛(弱推荐)。3)对于有抑郁症和可卡因消费的患者,不建议使用SSRI抗抑郁药来改善抑郁症状(弱推荐)或减少可卡因的使用(强推荐)。非ssri类抗抑郁药的使用仅推荐用于改善抑郁症状(强烈推荐)。4)不建议服用安非他酮来减少尼古丁的摄入(强烈建议)。5)心理治疗方面,在抑郁症合并酒精障碍患者中,药物治疗和认知行为治疗对症状内化和减少酒精摄入均有积极作用(弱推荐)。我们的综述表明,需要在这一领域进行更多的研究,并进行更大规模的、多地点的、随机的研究,以提供更明确的证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Adicciones
Adicciones SUBSTANCE ABUSE-
CiteScore
4.00
自引率
10.00%
发文量
36
审稿时长
>12 weeks
期刊介绍: Adicciones publica artículos originales sobre el tratamiento, la prevención, estudios básicos y descriptivos en el campo de las adicciones, como son las drogas ilegales, el alcohol, el tabaco o cualquier otra adicción, procedentes de distintas disciplinas (medicina, psicología, investigación básica, investigación social, etc.). Todos los artículos son seleccionados después de pasar un proceso de revisión anónimo hecho por expertos en ese tema.
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