Cocaine and depressive disorders: When standard clinical diagnosis is insufficient

Authors

  • Maria Alías-Ferri Institut Hospital del Mar d’Investigacions Mèdiques. Universitat Autònoma de Barcelona.
  • Nuria García-Marchena Institut Hospital del Mar d’Investigacions Mèdiques. Instituto de Investigación Biomédica de Málaga
  • Joan Ignasi Mestre-Pintó Institut Hospital del Mar d’Investigacions Mèdiques. Instituto de Investigación Biomédica de Málaga
  • Pedro Araos Instituto de Investigación Biomédica de Málaga
  • Esperanza Vergara-Moragues Universidad Complutense de Madrid
  • Francina Fonseca Institut Hospital del Mar d’Investigacions Mèdiques. Universitat Autònoma de Barcelona. Institut de Neuropsiquiatria i Addiccions
  • Francisco González-Saiz Universidad de Cádiz
  • Fernando Rodríguez de Fonseca Instituto de Investigación Biomédica de Málaga
  • Marta Torrens Institut Hospital del Mar d’Investigacions Mèdiques. Universitat Autònoma de Barcelona. Institut de Neuropsiquiatria i Addiccions.
  • NEURODEP Group

DOI:

https://doi.org/10.20882/adicciones.1321

Keywords:

Dual diagnosis, cocaine use disorder, cocaine-related disorders, depressive disorder, induced depression.

Abstract

Background: Cocaine use is a growing global health problem and patients with cocaine use disorders (CUD) present several complications, including high rates of major depression. These subjects present two types of major depressive disorder (MDD): primary major depressive disorder (P-MDD) and cocaine-induced major depressive disorder (CI-MDD). To improve treatment, it is necessary to distinguish between both types. The aim of this study was to assess the differences in depressive symptomatology criteria (P-MDD vs CI-MDD) in CUD patients. Methods: Secondary data analysis was carried out with a cross-sectional sample of 160 patients presenting CUD and MDD. Clinical assessment was performed using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). A differential diagnosis was obtained between P-MDD and CI-MDD. Results: Men represented 80% of the sample, the mean age was 38.61 years, and 64.5% had elementary studies. CI-MDD diagnosis (61.3%) was more frequent than P-MDD (38.7%). There was a younger age of CUD onset in CI-MDD patients. In addition, 79.4% of the patients had another substance use disorder diagnosis. The criterion “Changes in weight or appetite” was more prevalent (57.1%) in P-MDD group. Conclusions: We found differences in the criterion “Changes in weight or appetite”. Further research is needed in this field to establish a differential diagnosis and thus provide better treatment for CUD patients.

Author Biographies

Maria Alías-Ferri, Institut Hospital del Mar d’Investigacions Mèdiques. Universitat Autònoma de Barcelona.

Grup de Recerca en Addiccions, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM). Barcelona, España.Depart. de Psiquiatria i Medicina Forense. Universitat Autònoma de Barcelona, Cerdanyola del Valles. Barcelona, España.

Nuria García-Marchena, Institut Hospital del Mar d’Investigacions Mèdiques. Instituto de Investigación Biomédica de Málaga

Grup de Recerca en Addiccions, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM). Barcelona, España.Unidad Gestión Clínica de Salud Mental. Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga. Málaga, España.

Joan Ignasi Mestre-Pintó, Institut Hospital del Mar d’Investigacions Mèdiques. Instituto de Investigación Biomédica de Málaga

Grup de Recerca en Addiccions, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM). Barcelona, España.Departamento de Psicobiología y Metodología de las Ciencias del Comportamiento, Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Psicología, Universidad de Málaga. Málaga, España.

Pedro Araos, Instituto de Investigación Biomédica de Málaga

Unidad Gestión Clínica de Salud Mental. Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga. Málaga, España.

Esperanza Vergara-Moragues, Universidad Complutense de Madrid

+Depart. de Psicobiología y Metodología en Ciencias del Comportamiento, Univ. Complutense de Madrid (UCM). Madrid, España.

Francina Fonseca, Institut Hospital del Mar d’Investigacions Mèdiques. Universitat Autònoma de Barcelona. Institut de Neuropsiquiatria i Addiccions

Grup de Recerca en Addiccions, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM). Barcelona, España.Universitat Autònoma de Barcelona, Cerdanyola del Valles. Barcelona, España.Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar. Barcelona, España.

Francisco González-Saiz, Universidad de Cádiz

Área de Psiquiatría. Departamento de Neurociencias (Universidad de Cádiz). Hospital Universitario de Jerez. Cádiz, España.

Fernando Rodríguez de Fonseca, Instituto de Investigación Biomédica de Málaga

Unidad Gestión Clínica de Salud Mental. Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga. Málaga, España.

Marta Torrens, Institut Hospital del Mar d’Investigacions Mèdiques. Universitat Autònoma de Barcelona. Institut de Neuropsiquiatria i Addiccions.

Grup de Recerca en Addiccions, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM). Barcelona, España.Universitat Autònoma de Barcelona, Cerdanyola del Valles. Barcelona, España.Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar. Barcelona, España.

NEURODEP Group

NEURODEP Group: Mateus, J., Papaseit, E., Pérez-Mañá, C., Rodríguez-Minguela, R., Rossi, P., Tamarit, C., Vallecillo, G.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington, DC: APA.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, DC: APA.

Araos, P., Vergara-Moragues, E., Pedraz, M., Pavón, F. J., Campos Cloute, R., Calado, M.,… Rodríguez de Fonseca, F. (2014). Psychopathological comorbidity in cocaine users in outpatient treatment.Adicciones, 26, 15–26. doi:10.20882/adicciones.124

Araos, P., Vergara-Moragues, E., González-Saiz, F., Pedraz, M., García-Marchena, N., Romero-Sanchiz, P.,… Rodriguez De Fonseca, F. (2017). Differences in the rates of drug polyconsumption and psychiatric comorbidity among patients with cocaine use disorders according to the mental health service. Journal of Psychoactive Drugs, 49, 306–315. doi:10.1080/02791072.2017.1342151.

Bobes, B. M., Flórez, G., Seijo, P. y Bobes, G. J. (2019). Does ICD-11 improve the epidemiological and nosological purposes of mental, behavioral and developmental disorders? Adicciones, 31, 183. doi:10.20882/adicciones.1368.

Cohn, A. M., Epstein, E. E., McCrady, B. S., Jensen, N., Hunter-Reel, D., Green, K. E. y Drapkin, M. L. (2011). Pretreatment clinical and risk correlates of substance use disorder patients with primary depression. Journal of Studies on Alcohol and Drugs, 72, 151–157. doi: 10.15288/ jsad.2011.72.151.

Conner, K. R., Gamble, S. A., Bagge, C. L., He, H., Swogger,M. T., Watts, A. y Houston, R. J. (2014). Substance-induced depression and independent depression in proximal risk for suicidal behavior. Journal of Studies on Alcohol and Drugs, 75, 567–572. doi:10.15288/jsad.2014.75.567.

Dakwar, E., Nunes, E. V., Bisaga, A., Carpenter, K. C., Mariani, J. P., Sullivan, M. A.,… Levin, F. R. (2011). A comparison of independent depression and substance-induced depression in cannabis-, cocaine-, and opioid-dependent treatment seekers. American Journal on Addictions, 20, 441–446. doi:10.1111/j.1521-0391.2011.00148.x.

Davis, L., Uezato, A., Newell, J. M. y Frazier, E. (2008). Major depression and comorbid substance use disorders. Current Opinion in Psychiatry, 21, 14–18. doi:10.1097/ YCO.0b013e3282f32408.

Foulds, J. A., Sellman, J. D., Adamson, S. J., Boden, J. M., Mulder, R. T. y Joyce, P. R. (2015). Depression outcome in alcohol dependent patients: An evaluation of the role of independent and substance-induced depression and other predictors. Journal of Affective Disorders, 174, 503–510. doi:10.1016/j.jad.2014.11.052.

García-Fernández, G., Secades-Villa, R., García-Rodríguez, O., Peña-Suárez, E. y Sánchez-Hervás, E. (2013). Contingency management improves outcomes in cocaine-dependent outpatients with depressive symptoms. Experimental and Clinical Psychopharmacology, 21, 482-489. doi:10.1016/j.jsat.2012.08.018.

Grant, B. F. y Dawson, D. A. (1998). Age of onset of drug use and its association with DSM-IV drug abuse and dependence: Results from the national longitudinal alcohol epidemiologic survey. Journal of Substance Abuse, 10, 163–173. doi:10.1016/s0899-3289(97)90009-2.

Hasin, D. S., Samet, W. E., Nunes, J., Meydan, K., Matseoane, B. A. R. y Waxman, B. A. (2006). Diagnosis of comorbid psychiatric disorders in substance users assessed with the Psychiatric Research Interview for Substance and Mental Disorders for DSM-IV. American Journal of Psychiatry, 163, 689-696.

Herrero, M. J., Domingo-Salvany, A., Torrens, M., Brugal, M. T. y ITINERE Investigators. (2008). Psychiatric comorbidity in young cocaine users: Induced versus independent disorders. Addiction, 103, 284–293. doi:10.1111/j.1360-0443.2007.02076.x.

Herrero, M. J., Domingo-Salvany, A., Brugal, M. T., Torrens, M. y ITINERE Investigators. (2011). Incidence of psychopathology in a cohort of young heroin and/ or cocaine users. Journal of Substance Abuse Treatment, 41, 55–63. doi:10.1176/ajp.2006.163.4.689.

John, W. S. y Wu, L. T. (2017). Trends and correlates of cocaine use and cocaine use disorder in the United States from 2011 to 2015. Drug and Alcohol Dependence, 180, 376–384. doi:10.1016/j.drugalcdep.2017.08.031.

Jordan, C. J. y Andersen, S. L. (2017). Sensitive periods of substance abuse: Early risk for the transition to dependence. Developmental Cognitive Neuroscience, 25, 29–44. doi:10.1016/j.dcn.2016.10.004.

Keller, B., Mestre-Pinto, J.-I., Álvaro-Bartolomé, M., Martinez-Sanvisens, D., Farre, M., García-Fuster, M. J., NEURODEP Group. (2017). A biomarker to differentiate between primary and cocaine-induced major depression in cocaine use disorder: The role of platelet IRAS/Nischarin (I1-Imidazoline Receptor). Frontiers in Psychiatry, 8, 258. doi:10.3389/fpsyt.2017.00258.

Lai, H. M. X., Cleary, M., Sitharthan, T. y Hunt, G. E. (2015). Prevalence of comorbid substance use, anxietyand mood disorders in epidemiological surveys, 1990– 2014: A systematic review and meta-analysis. Drug and Alcohol Dependence, 154, 1–13. doi:10.1016/j.drugalcdep.2015.05.031.

Langås, A. M., Malt, U. F. y Opjordsmoen, S. (2013). Independent versus substance-induced major depressive disorders in first-admission patients with substance use disorders: An exploratory study. Journal of Affective Disorders, 144, 279–283. doi:10.4088/jcp.v67n1010.

Leventhal, A. M., Mooney, M. E., DeLaune, K. A. y Schmitz,J. M. (2006). Using addiction severity profiles to differentiate cocaine- dependent patients with and without comorbid major depression. American Journal on Addictions, 15, 362–369. doi:10.1080/10550490600860148.

Magidson, J. F., Wang, S., Lejuez, C. W., Iza, M. y Blanco,C. (2013). Prospective study of substance-induced and independent major depressive disorder among individuals with substance use disorders in a nationally representative sample. Depression and Anxiety, 30, 538–545. doi:10.1002/da.22122.

Nunes, E. V, Liu, X., Samet, S., Matseoane, K. y Hasin, D. (2006). Independent versus substance-induced major depressive disorder in substance-dependent patients: Observational study of course during follow-up. Journal of Clinical Psychiatry, 67, 1561–1567. doi:10.4088/jcp. v67n1010.

Raimo, E. B. y Schuckit, M. A. (1998). Alcohol dependence and mood disorders. Addictive Behaviors, 23, 933-946. doi:10.1016/s0306-4603(98)00068-9.

Saltiel, P. F. y Silvershein, D. I. (2015). Major depressive disorder: Mechanism-based prescribing for personalized medicine. Neuropsychiatric Disease and Treatment, 11, 875- 888. doi:10.2147/NDT.S73261.

Samet, S., Fenton, M. C., Nunes, E., Greenstein, E., Aharonovich, E. y Hasin, D. (2013). Effects of independent and substance-induced major depressive disorder on remission and relapse of alcohol, cocaine and heroin dependence. Addiction, 108, 115–123. doi:10.1111/j.1360- 0443.2012.04010.x.

Schuckit, M. A., Tipp, J. E., Bergman, M., Reich, W., Hesselbrock, V. M. y Smith, T. L. (1997). Comparison of induced and independent major depressive disorders in 2,945 alcoholics. American Journal of Psychiatry, 154, 948–957. doi:10.1176/ajp.154.7.948.

Tirado Muñoz, J., Farré, A., Mestre-Pintó, J., Szerman, N. y Torrens, M. (2018). Dual diagnosis in depression: Treatment recommendations. Adicciones, 30, 66-76. doi:10.20882/adicciones.868.

Torrens, M., Serrano, D., Astals, M., Pérez-Domínguez, G. y Martín-Santos, R. (2004). Diagnosing comorbid psychiatric disorders in substance abusers: Validity of the Spanish versions of the Psychiatric Research Interview for Substance and Mental Disorders and the Structured Clinical Interview for DSM-IV. American Journal of Psychiatry, 161, 1231–1237. doi:10.1176/appi.ajp.161.7.1231.

Torrens, M. (2008). Patología dual: Situación actual y retos de futuro. Adicciones, 20, 315–319. doi:10.20882/adicciones.255.

United Nations Office on Drugs and Crime (UNODC). (2016a). Annual prevalence of the use of drugs by region and globally | Statistics and Data.

United Nations Office on Drugs and Crime (UNODC). (2016b). Drug treatment in Europe | Statistics and Data.

Yang, B.-Z., Han, S., Kranzler, H. R., Farrer, L. A. y Gelernter, J. (2011). A genomewide linkage scan of cocaine dependence and major depressive episode in two populations. Neuropsychopharmacology, 36, 2422–2430. doi:10.1038/npp.2011.122.

Published

2020-02-06

Issue

Section

Originals