Depression treatment low in patients with co-occurring substance use disorder

Patients with comorbid substance use disorder do not always receive guideline-concordant depression therapy despite the availability of effective treatments for depression, a study has found.

“Clinical practice guidelines recommend concurrent treatment of co-occurring depression and substance use disorders,” the investigators said.

The association of comorbid substance use disorders with guideline-concordant depression treatment, including both medication and psychotherapy, was assessed in a retrospective cohort study of 53,034 patients diagnosed with a depressive disorder in fiscal year 2017 in the US Veterans Health Administrations, with adjustments for patients’ demographics and clinical characteristics.

Across metrics, fewer patients with co-occurring depression and substance use disorders underwent guideline-concordant depression treatment than those without substance use disorders.

Findings were consistent in covariate-adjusted models of antidepressant treatment: patients with substance use disorders were less likely to receive guideline-concordant acute treatment (adjusted odds ratio [aOR], 0.79, 95 percent confidence interval [CI], 0.73–0.84) and to continue treatment (aOR, 0.74, 95 percent CI, 0.69–0.79).

In terms of psychotherapy, patients with co-occurring depression and substance use disorders also had a lower likelihood of receiving adequate acute-phase treatment (aOR, 0.87, 95 percent CI, 0.82–0.91) and of continuing therapy (aOR, 0.81, 95 percent CI, 0.73–0.89).

“Efforts to improve the provision of care to those with co-occurring substance use disorders should focus on clinician-based interventions and use of integrated care models to improve the quality of depression treatment,” the investigators said.