Patients with AUD Have Fewer Relapses When Antidepressants Improve Depression

A new study demonstrated the number of relapses among patients with alcohol use disorder (AUD) depends on whether their depression symptoms improve on antidepressants.¹ If their depression symptoms did not improve, the patient was likely to have more relapses. Conversely, patients with improved depression symptoms had fewer relapses.

“Our findings advocate for a dual pathway framework in which antidepressants concomitantly are negatively and positively associated with alcohol use,” wrote investigators, led by Joshua Jaeger, PhD, from the department of clinical psychology and psychotherapy, Institute of Psychology at University of Bern, in Switzerland. “Specifically, our findings revealed statistically a negative direct effect of antidepressants on abstinence three-month post-discharge and a positive indirect effect mediated by reduced depression symptoms.”

Both AUD and depression may lead to significant psychological, physiological, social, and economic consequences. Many patients with AUD develop depression symptoms, which often occur during or after alcohol withdrawal, but the symptoms frequently disappear untreated with medium to long-term abstinence after 3 – 4 weeks.²

It is unknown what challenges the co-occurrence of AUD and depression could present, nor how antidepressant medication influences AUD outcomes. Jaeger and colleagues conducted a multicenter, longitudinal study to evaluate the relationship between antidepressant medication and shifts in depression symptoms and alcohol use among patients with AUD.

The team leveraged data from the double-blind, randomized clinical trial on alcohol-specific inhibition training among patients with AUD.³ They analyzed 153 detoxified AUD patients who attended a 12-week residential treatment program between 2015, and 2019.

Participants were included in the study if they had a diagnosis of AUD according to DSM-5 and were 18 – 60 years old.¹ Investigators examined 3 relevant time points: discharge, 3-month follow-up, and after residential treatment discharge.

Participants were categorized into the following groups: nonselective monoamine reuptake inhibitors, selective serotonin reuptake inhibitors, and other antidepressants. Selective serotonin reuptake inhibitors were the most used antidepressant medication.

Investigators used a mediation analysis with a bootstrapping approach and a quasi-Bayesian framework. In the study they estimated the total, direct, and mediated effects of antidepressants on the percentage of days abstinent, hoping to evaluate the role of changes in depression symptoms as a mediating factor.

Ultimately, the analysis demonstrated a dual impact pathway model with a negative direct effect of antidepressants on abstinence (P = .004) and a positive indirect effect, mediated through the reduction of depression symptoms (P = .002). Investigators observed no evidence of a total effect between antidepressant medication and abstinence (P > .05).

Investigators found patients receiving antidepressants had 12.4 fewer days abstinent compared to patients not receiving antidepressants. However, after controlling for other factors, the team saw patients who received antidepressants had significantly fewer abstinent days in the 3 months after treatment than patients who did not receive antidepressants.

A mediation analysis showed a statistically significant indirect effect of 3.60 (95% confidence interval [CI], 1.07 – 7.28; P = .002). Ultimately, this suggests changes in depression symptoms mediate the effect of antidepressant use on changes in particular outcomes.

“…our study provides a rationale to characterize the relationship between antidepressant medication, post-discharge alcohol use, and depression symptoms in patients attending residential AUD treatment, by proposing a dual effect pathway framework,” investigators concluded. “This framework highlights the potential benefits and drawbacks—i.e., a negative association of antidepressants and alleviation of depressive symptoms, respectively with abstinence at three-month follow-up. Our findings call for personalized clinical decision-making based on vigilant monitoring of depression symptoms and adopting tailored treatment approaches to optimize AUD treatment outcomes.”

References

1. ^{Jaeger, J, Osterburg, L, Stein, M. Antidepressants and Alcohol Use Disorder: A Multicenter Study On The Mediating Role Of Depression Symptom Changes. Wiley. July 26, 2024. https://onlinelibrary.wiley.com/doi/10.1111/acer.15386. Accessed July 26, 2024.}
2. ^{Farré, A., Tirado, J., Spataro, N., Alías-Ferri, M., Torrens, M. & Fonseca, F. (2020) Alcohol induced depression: clinical, biological and genetic features. Journal of Clinical Medicine, 9, E2668. Available from: https://doi.org/10.3390/jcm9082668}
3. ^{Tschuemperlin, R.M., Stein, M., Batschelet, H.M., Moggi, F. & Soravia, L.M. (2019) Learning to resist the urge: a double-blind, randomized controlled trial investigating alcohol-specific inhibition training in abstinent patients with alcohol use disorder. Trials, 20, 402. Available from: https://doi.org/10.1186/s13063-019-3505-2}