Patología dual en Depresión: recomendaciones en el tratamiento

Judit Tirado Muñoz, Adriana Farré, Joan Mestre-Pintó, Nestor Szerman, Marta Torrens

Resumen


La comorbilidad entre los trastornos por uso de sustancias (SUD) y la depresión mayor (DM) es la patología dual más común en el campo de las adicciones a sustancias, con prevalencias que oscilan entre el 12 y el 80% complicando la respuesta al tratamiento y empeorando el pronóstico de los pacientes.
Diferenciar entre el diagnóstico de episodios depresivos inducidos y episodios depresivos primarios concurrentes al uso de sustancias es especialmente relevante para el manejo terapéutico.
En este artículo se presenta el estado actual de los tratamientos farmacológicos disponibles hasta el momento para la depresión comórbida en pacientes con SUD, teniendo en cuenta la seguridad y el potencial de abuso de los fármacos antidepresivos.
Debido a que la comorbilidad de DM y SUD es frecuente y a que estos pacientes presentan mayor gravedad psicopatológica y peor funcionamiento social, es crucial un modelo de tratamiento integrado y no abordar el tratamiento por separado.

Palabras clave


Depresión; Patología dual; Comorbilidad; Tratamiento; Recomendaciones

Texto completo:

PDF PDF (English)

Referencias


Agosti, V. y Levin, F. R. (2006). One-year follow-up study of suicide attempters treated for drug dependence. The American Journal on Addictions, 15, 293–296. http://doi.org/10.1080/10550490600754333.

American Psychiatric Association, APA (1994). DSM-IV. Manual diagnóstico y estadístico de los trastornos mentales. Barcelona: Masson.

American Psychiatric Association, APA (2002). DSM-IV-TR. Manual diagnóstico y estadístico de los trastornos mentales. Texto Revisado. Barcelona: Masson.

American Psychiatric Association, APA. (2013). DSM-V. Manual diagnóstico y estadístico de los trastornos mentales. Barcelona: Masson.

Arias, F., Szerman, N., Vega, P., Mesias, B., Basurte, I., Morant, C., … Babín, F. (2013). Madrid study on the prevalence and characteristics of outpatients with dual pathology in community mental health and substance misuse services. Adicciones, 25, 118–27. doi:10.1080/17523281.2012.748674.

Belmaker, R. H. y Agam, G. (2008). Major depressive disorder. The New England Journal of Medicine, 358, 55–68. doi:10.1056/NEJMra073096.

Boden, J. M. y Fergusson, D. M. (2011). Alcohol and depression. Addiction, 106, 906–914. Doi:10.1111/j.1360-0443.2010.03351.x.

Brady, K. T. y Sinha, R. (2005). Co-occurring mental and substance use disorders: The neurobiological effects of chronic stress. American Journal of Psychiatry, 162, 1483–1493. doi:10.1176/appi.ajp.162.8.1483.

Chou, R., Cruciani, R. A., Fiellin, D. A., Compton, P., Farrar, J. T., Haigney, M. C., … Heart Rhythm Society. (2014). Methadone safety: a clinical practice guideline from the American Pain Society and College on Problems of Drug Dependence, in collaboration with the Heart Rhythm Society. The Journal of Pain : Official Journal of the American Pain Society, 15, 321–337. doi:10.1016/j.jpain.2014.01.494.

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.

EMCDDA. (2015). Comorbidity of substance use and mental disorders in Europe. Luxembourg. doi:10.2810/532790.

Evans, E. A. y Sullivan, M. A. (2014). Abuse and misuse of antidepressants. Substance Abuse and Rehabilitation, 5, 107–120. doi:10.2147/SAR.S37917.

Gutiérrez-Sacristán, A., Grosdidier, S., Valverde, O., Torrens, M., Bravo, À., Piñero, J., … Furlong, L. I. (2015). PsyGeNET: a knowledge platform on psychiatric disorders and their genes. Bioinformatics (Oxford, England), 31, 3075–3077. doi:10.1093/bioinformatics/btv301.

Haddad, P. (1999). Do antidepressants have any potential to cause addiction? Journal of Psychopharmacology (Oxford, England), 13, 300–307.

Hasin, D. S., Trautman, K. D., Miele, G. M., Samet, S., Smith, M. y Endicott, J. (1996). Psychiatric Research Interview for Substance and Mental Disorders (PRISM): reliability for substance abusers. The American Journal of Psychiatry, 153, 1195–201. doi.org/10.1176/ajp.153.9.1195.

Jasinski, D. R., Faries, D. E., Moore, R. J., Schuh, L. M. y Allen, A. J. (2008). Abuse liability assessment of atomoxetine in a drug-abusing population. Drug and Alcohol Dependence, 95, 140–146. doi:10.1016/j.drugalcdep.2008.01.008.

Kao, D., Bucher Bartelson, B., Khatri, V., Dart, R., Mehler, P. S., Katz, D. y Krantz, M. J. (2013). Trends in reporting methadone-associated cardiac arrhythmia, 1997-2011: an analysis of registry data. Annals of Internal Medicine, 158, 735–740. doi:10.7326/0003-4819-158-10-201305210-00008.

Krishnan, V. y Nestler, E. J. (2010). Linking molecules to mood: new insight into the biology of depression. The American Journal of Psychiatry, 167, 1305–1320. doi:10.1176/appi.ajp.2009.10030434.

Lai, H. M. X., Cleary, M., Sitharthan, T. y Hunt, G. E. (2015). Prevalence of comorbid substance use, anxiety and 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.

Landheim, A. S., Bakken, K. y Vaglum, P. (2006). Impact of comorbid psychiatric disorders on the outcome of substance abusers: a six year prospective follow-up in two Norwegian counties. BMC Psychiatry, 6, 44. doi:10.1186/1471-244X-6-44.

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:10.1016/j.jad.2012.10.008.

Levin, F. R., Mariani, J., Brooks, D. J., Pavlicova, M., Nunes, E. V, Agosti, V., … Carpenter, K. M. (2013). A randomized double-blind, placebo-controlled trial of venlafaxine-extended release for co-occurring cannabis dependence and depressive disorders. Addiction (Abingdon, England), 108, 1084–1094. doi:10.1111/add.12108.

Marmorstein, N. R. (2011). Associations between subtypes of major depressive episodes and substance use disorders. Psychiatry Research, 186, 248–253. doi:10.1016/j.psychres.2010.10.003.

Martin-Santos, R., Fonseca, F., Domingo-Salvany, A., Gines, J. M., Imaz, M. L., Navines, R., … Torrens, M. (2006). Dual Diagnosis in the Psychiatric Emergency Room in Spain. The European Journal of Psychiatry, 20, 147-156.

Mueller, T. I., Lavori, P. W., Keller, M. B., Swartz, A., Warshaw, M., Hasin, D., … Akiskal, H. (1994). Prognostic effect of the variable course of alcoholism on the 10-year course of depression. The American Journal of Psychiatry, 151, 701–706. doi:10.1176/ajp.151.5.701.

Nestler, E. J. y Carlezon, W. A. (2006). The Mesolimbic Dopamine Reward Circuit in Depression. Biological Psychiatry, 59, 1151–1159. doi:10.1016/j.biopsych.2005.09.018.

Nunes, E. V. y Levin, F. R. (2004). Treatment of depression in patients with alcohol or other drug dependence: a meta-analysis. JAMA : The Journal of the American Medical Association, 291, 1887–1896. doi:org/10.1001/jama.291.15.1887.

Pani, P. P., Vacca, R., Trogu, E., Amato, L. y Davoli, M. (2010). Pharmacological treatment for depression during opioid agonist treatment for opioid dependence. The Cochrane Database of Systematic Reviews, 9, CD008373. doi:10.1002/14651858.CD008373.pub2.

Pettinati, H. M., O’Brien, C. P. y Dundon, W. D. (2013). Current status of co-occurring mood and substance use disorders: a new therapeutic target. The American Journal of Psychiatry, 170, 23–30. doi:10.1176/appi.ajp.2012.12010112.

Reeves, R. R., Ladner, M. E., Perry, C. L., Burke, R. S. y Laizer, J. T. (2015). Abuse of medications that theoretically are without abuse potential. Southern Medical Journal, 108, 151–157. doi:10.14423/SMJ.0000000000000256.

Riper, H., Andersson, G., Hunter, S. B., de Wit, J., Berking, M. y Cuijpers, P. (2014). Treatment of comorbid alcohol use disorders and depression with cognitive-behavioural therapy and motivational interviewing: A meta-analysis. Addiction, 109, 394-406. doi:10.1111/add.12441.

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.

San, L., Arranz, B. y Grupo de Expertos de la Guía de Práctica Clínica de Patología Dual. (2016). Guía de práctica clínica para el tratamiento de patología dual en población adulta. Adicciones, 28, 3-5. doi:10.20882/adicciones.784.

Schuckit, M. A. (2006). Comorbidity between substance use disorders and psychiatric conditions. Addiction, 101, 76-88. doi:10.1111/j.1360-0443.2006.01592.x.

Schuckit, M. A., Smith, T. L. y Kalmijn, J. (2013). Relationships among independent major depressions, alcohol use, and other substance use and related problems over 30 years in 397 families. Journal of Studies on Alcohol and Drugs, 74, 271–279.

Szerman, N., Arias, F., Vega, P., Babín, F. D. A., Mesías, B., Basurte, I., … Grupo de Investigación del estudio piloto sobre la prevalencia de patología dual en pacientes en tratamiento en la Comunidad de Madrid. Estudio piloto sobre la prevalencia de patología dual en pacientes en tratamiento en la Comunidad de Madrid, Adicciones, 23, 249–255.

Torrens, M., Fonseca, F., Mateu, G. y Farre, M. (2005). Efficacy of antidepressants in substance use disorders with and without comorbid depression: A systematic review and meta-analysis. Drug and Alcohol Dependence, 78, 1–22. doi:10.1016/j.drugalcdep.2004.09.004.

Torrens, M., Gilchrist, G. y Domingo-Salvany, A. (2011). Psychiatric comorbidity in illicit drug users: Substance-induced versus independent disorders. Drug and Alcohol Dependence, 113, 147–156. doi:10.1016/j.drugalcdep.2010.07.013.

Torrens, M., Martínez-Sanvisens, D., Martínez-Riera, R., Bulbena, A., Szerman, N. y Ruiz, P. (2011). Dual Diagnosis: Focusing on Depression and Recommendations for Treatment. Addictive Disorders y Their Treatment, 10, 50–59. doi:10.1097/ADT.0b013e318215f322.

Torrens, M. y Rossi, P. (2015). Mood disorders and addiction. In G. Dom y F. Moggi (Eds.), Co-Occurring Addictive and Psychiatric Disorders: A Practice-Based Handbook from A European Perspective (1st ed., pp. 103–117). Berlin, Heidelberg: Springer Berlin Heidelberg. doi:10.1007/978-3-642-45375-5_8.

Torrens, M., Rossi, P. C., Martinez-Riera, R., Martinez-Sanvisens, D. y Bulbena, A. (2012). Psychiatric co-morbidity and substance use disorders: Treatment in parallel systems or in one integrated system. Substance Use and Misuse, 47, 1005–1014. doi:10.3109/10826084.2012.663296.

Valverde, O., Célérier, E., Baranyi, M., Vanderhaeghen, P., Maldonado, R., Sperlagh, B., … Ledent, C. (2009). GPR3 receptor, a novel actor in the emotional-like responses. PloS One, 4, e4704. doi:10.1371/journal.pone.0004704.

Valverde, O. y Torrens, M. (2012). CB1 receptor-deficient mice as a model for depression. Neuroscience, 204, 193–206. doi:10.1016/j.neuroscience.2011.09.031.

Volkow, N. D., Wang, G.-J., Fowler, J. S., Learned-Coughlin, S., Yang, J., Logan, J., … Xu, Y. (2005). The slow and long-lasting blockade of dopamine transporters in human brain induced by the new antidepressant drug radafaxine predict poor reinforcing effects. Biological Psychiatry, 57, 640–646. doi:10.1016/j.biopsych.2004.12.007.

Watkins, K. E., Hunter, S. B., Hepner, K. A., Paddock, S. M., de la Cruz, E., Zhou, A. J. y Gilmore, J. (2011). An effectiveness trial of group cognitive behavioral therapy for patients with persistent depressive symptoms in substance abuse treatment. Archives of General Psychiatry, 68, 577–584. doi:10.1001/archgenpsychiatry.2011.53.

Wise, R. A. (1989). Opiate reward: Sites and substrates. Neuroscience and Biobehavioral Reviews, 13, 129–133. doi:10.1016/S0149-7634(89)80021-1.




DOI: https://doi.org/10.20882/adicciones.868

Enlaces refback

  • No hay ningún enlace refback.