Treating depression complicated by substance misuse

Claire Mcintosh, Bruce Ritson

Research output: Contribution to journalArticlepeer-review

37 Citations (Scopus)


Patients presenting with depression complicated by substance misuse pose particular challenges in their management. Their depressive symptoms are very likely to be caused or exacerbated by their substance misuse. In alcohol misuse, a 1-month period of abstinence and then further evaluation are recommended before the commencement of pharmacotherapy. Opiate users should be stabilised before pharmacotherapy. Prescription of antidepressants must be very carefully considered, as they have a street value and might therefore be widely disseminated; also, there is little evidence supporting their efficacy in treating depressive symptoms in this group. SSRIs would be the treatment of choice. Strong consideration should be given to psychological therapies such as motivational interviewing and cognitive-behavioural therapy, which are currently being further evaluated and hopefully should become more available to patients with comorbidity. Equally, treatment of depressive symptoms also yields benefit in managing substance misuse, with antidepressant treatment decreasing alcohol intake in alcoholics with depression.
Original languageEnglish
Pages (from-to)357-364
Number of pages8
JournalAdvances in Psychiatric Treatment
Issue number5
Publication statusPublished - 2001


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