The relationship between opioid abuse and severity of depression

Abstract

Depression is a prominent part of the clinical profile of opioid abusers. The purpose of this investigation is to examine critical issues concerned with the etiology of this depression. The results of this examination are intended to provide a basis for developing effective treatment strategies for depressed opioid abusers.;Thirty subjects, who satisfied DSM-3 criteria for opioid abuse disorder were assessed during processing, on the day of admission, and subsequent to an inpatient medical detoxification, which occurred over about ten days. Assessment instruments include: the Beck Depression Inventory-short form; the Millon Clinical Multi-axial Inventory; the Subjective Opiate Withdrawal Scale; and the Substance Abuse Interview.;The results of subject assessments are as follows. Subjects who are clinically (pathologically) depressed prior to detoxification are generally sub-clinically (non-pathologically) depressed subsequent to detoxification (T = 11.89, D.F. = 23, P {dollar}<{dollar}.001). Subjects who are sub-clinically depressed prior to detoxification remain sub-clinically depressed subsequent to detoxification (T = 4.61, D.F. = 5, P {dollar}<{dollar}.01). Frequency of daily opioid self-administration is not significantly correlated with severity of depression, experienced prior to detoxification (P =.44). And the amount of cocaine used is not significantly correlated with the severity of depressive de-energization symptoms experienced, prior to detoxification (P =.20). In addition, ten forms of clinical level psychopathology are found among clinically depressed opioid abusers, prior to detoxification. Subsequent to detoxification, clinical level psychopathology (and clinical level depression) generally remits in all diagnostic categories except Narcissistic personality disorder.;These results appear to lend support for the etiological theory that depressive symptomatology represents a drug effect of opioid abuse. However, serious limitations to this conclusion were found. Subjects generally experienced sub-clinical level psychopathology subsequent to detoxification. Thus, this time may be a critical period in their treatment in which they are ameniable to professional intervention. Treatment strategies, suggestive of this result include: extending opioid abusers hospital stay subsequent to detoxification; providing psychotherapy, and discussing post-hospitalization substance abuse treatment with them during this post-detoxification period. In addition, caution should be taken with respect to administering antidepressant medication to clinically depressed opioid abusers.