Treatment outcomes in major depressive disorder in patients with comorbid alcohol use disorder: A STAR*D analysis

Victor M Tang; Dengdeng Yu; Cory R Weissman; Brett D M Jones; Guan Wang; Matthew E Sloan; Daniel M Blumberger; Zafiris J Daskalakis; Bernard Le Foll; Daphne Voineskos

doi:10.1016/j.jad.2023.07.049

Treatment outcomes in major depressive disorder in patients with comorbid alcohol use disorder: A STAR*D analysis

J Affect Disord. 2023 Oct 15:339:691-697. doi: 10.1016/j.jad.2023.07.049. Epub 2023 Jul 17.

Authors

Affiliations

¹ Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
² Department of Mathematics, University of Texas at Arlington, Arlington, TX, USA.
³ Department of Psychiatry, UC San Diego Health, La Jolla, CA, USA; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
⁴ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁵ Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁶ Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁷ Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
⁸ Department of Psychiatry, UC San Diego Health, La Jolla, CA, USA.
⁹ Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada.
¹⁰ Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Poul Hansen Family Centre for Depression, Krembil Research Institute, Toronto Western Hospital, University Health Network, Canada. Electronic address: daphne.voineskos@camh.ca.

PMID: 37467796
PMCID: PMC10496139 (available on 2024-10-15)
DOI: 10.1016/j.jad.2023.07.049

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.

Keywords: Alcohol Use Disorder; Antidepressants; Comorbidity; Major Depressive Disorder.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Alcoholism* / epidemiology
Antidepressive Agents / therapeutic use
Bupropion / therapeutic use
Comorbidity
Depressive Disorder, Major* / drug therapy
Depressive Disorder, Major* / epidemiology
Humans
Treatment Outcome
Venlafaxine Hydrochloride / therapeutic use

Substances

Venlafaxine Hydrochloride
Bupropion
Antidepressive Agents

Grants and funding

R25 DA033211/DA/NIDA NIH HHS/United States