Article ; Online: Treatment outcomes in major depressive disorder in patients with comorbid alcohol use disorder: A STAR*D analysis.
Journal of affective disorders
2023 Volume 339, Page(s) 691–697
Abstract: ... Alternatives to Relieve Depression (STAR*D) study, examining the association between comorbid AUD and ... depression outcomes.: Methods: STAR*D was a real-world effectiveness trial starting with citalopram ... predictors in the total STAR*D sample and the AUD-comorbidity interaction.: Results: Chi-squared tests ...
| Abstract | Introduction: Guidance on Major Depressive Disorder (MDD) treatment in those with comorbid Alcohol Use Disorder (AUD) is limited. We performed a secondary analysis on the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study, examining the association between comorbid AUD and depression outcomes. Methods: STAR*D was a real-world effectiveness trial starting with citalopram in level 1. Non-responding participants progressed through 3 other sequential treatment levels with different switch or augmentation options. Antidepressant outcomes were compared between MDD (n = 2826) and comorbid MDD and AUD (n = 864). Logistic regressions were performed to evaluate remission and response predictors in the total STAR*D sample and the AUD-comorbidity interaction. Results: Chi-squared tests showed no significant difference in response or remission rates from depression between groups across treatment levels. Higher Hamilton Rating Scale for Depression (HRSD) score was associated with overall lower odds of remission in treatment level 1 (OR = 0.93, p < 0.001) and 2 (OR = 0.95, p < 0.001), with no significant interaction with comorbid AUD. Higher baseline suicidality had overall lower odds of remission in level 1 (OR = 0.82, p < 0.001) and 2 (OR = 0.1, p < 0.001), but with comorbid AUD compared to no AUD, suicidality increased odds of level 1 remission (OR = 1.30, p = 0.012). In comorbid AUD in level 2, venlafaxine was associated with lower odds of remission (OR = 0.13, p = 0.013) and response (OR = 0.12, p = 0.006); bupropion with lower odds of response (OR = 0.22, p = 0.024). Limitations: Open label study design and lack of alcohol use data. Conclusions: Comorbid AUD may interact with predictors of antidepressant response in MDD and using venlafaxine or bupropion may be less effective. Addressing this comorbidity requires unique assessment and treatment approaches. |
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| MeSH term(s) | Humans ; Depressive Disorder, Major/drug therapy ; Depressive Disorder, Major/epidemiology ; Venlafaxine Hydrochloride/therapeutic use ; Alcoholism/epidemiology ; Bupropion/therapeutic use ; Antidepressive Agents/therapeutic use ; Treatment Outcome ; Comorbidity |
| Chemical Substances | Venlafaxine Hydrochloride (7D7RX5A8MO) ; Bupropion (01ZG3TPX31) ; Antidepressive Agents |
| Language | English |
| Publishing date | 2023-07-17 |
| Publishing country | Netherlands |
| Document type | Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 135449-8 |
| ISSN | 1573-2517 ; 0165-0327 |
| ISSN (online) | 1573-2517 |
| ISSN | 0165-0327 |
| DOI | 10.1016/j.jad.2023.07.049 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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