Effects of Major Depressive Disorder On Remission and Relapse of Alcohol, Cocaine and Heroin Dependence

Objective. Major depression during sustained remission from substance dependence increases the risk for relapse. However, whether this effect is specific to alcohol, cocaine or heroin dependence is unknown. Further, although DSM-IV was published 15 years ago, little research has addressed whether primary and substance-induced major depressive episodes predict post-hospital course (remission and relapse) of alcohol, cocaine and heroin dependence.

Method: Data were analyzed from a cohort of inpatients in a community psychiatric hospital (N=250) initially evaluated in 1995-1997, and re-interviewed 6, 12 and 18 months post-discharge. At baseline, patients met DSM-IV criteria for current alcohol, cocaine and/or heroin dependence and never experienced mania or non-affective psychosis. Survival analyses addressed three outcomes for alcohol, cocaine and heroin: (1) time (weeks) from hospital discharge to first use; (2) time from discharge to onset of sustained (≥26 weeks) dependence remission; (3) time from onset of sustained remission to relapse.

Results. Baseline substance-induced major depression predicted post-discharge use of alcohol, cocaine and heroin (hazard ratios 4.3, 4.8 and 6.9, respectively). Among patients achieving stable remission from alcohol, cocaine or heroin dependence, primary major depression more than doubled the hazard of relapse to alcohol and cocaine dependence (hazard ratios 2.2 and 2.6, respectively).

Conclusion: The impact of substance-induced depression on post-discharge return to use of alcohol, cocaine and heroin use suggested that this diagnostic category merits clinical attention. The impact of primary major depression on the risk for relapse to dependence during sustained remission indicates the importance of planning for, identifying and treating such depression.