Depressive symptoms in early alcohol or opioid abstinence: course & correlates

BACKGROUND Depressive symptoms are common during abstinence from psychoactive substances. Research caveats limit the study of persistence of significant depressive symptoms beyond four weeks of abstinence. This prospective study examined the course and correlates of depressive symptoms in patients with alcohol or opioid use disorder over 5-8 weeks. METHODS Sample consisted of 100 men randomly selected out of 307 inpatient men with either alcohol or opioid use disorder. Weekly assessments focused on depressive symptoms (HDRS, BDI), and their correlates (HAM-A for anxiety symptoms, CIWA-Ar and COWS for withdrawal symptoms, OCDS and OCDUS for craving for alcohol and opioids respectively). Other correlates assessed were severity of dependence and family support. PRISM (Psychiatric Research Interview for Substance and Mental disorders) was used for diagnosis of substance-induced depression and major depressive episode. Repeated measures ANOVA was used for weekly comparison of depressive symptoms. RESULTS Participants were dependent on opioids (56%), or alcohol (41%), or both (3%). Mean age was 33.5 years. Eighty-eight participants completed the study. Substance-induced depressive episode was diagnosed by PRISM in 59% participants. Weekly assessments of depressive symptoms recorded significant reductions (p < 0.0001; Wilk's Lambda for HDRS and BDI 137.01 and 105.4 respectively). Baseline depressive symptoms correlated significantly with anxiety, withdrawal symptoms, and negatively with social support. No participant was diagnosed with a major depressive episode at 6-8 weeks. CONCLUSION Depressive symptoms in early alcohol or opioid abstinence resolve significantly over a month; therefore, clinicians should exercise watchful waiting before starting antidepressant therapy.