Clinical practice guideline on pharmacological and psychological management of adult patients with depression and a comorbid substance use disorder

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Servicio Gallego de Salud (SERGAS) and Sociedad Espanola de Psiquiatria Biologica (SEPB)

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Florez GAuthorFarré MAuthorBernardo Arroyo, MiguelAuthorGarriga Carrizosa, MarinaAuthorLopez AAuthorGoikolea Alberdi, Jose ManuelAuthor

May 3, 2021

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Publicated to:Adicciones. 34 (2): 128-141 - 2022-01-01 34(2), DOI: 10.20882/adicciones.1559

Authors: Torrens, Marta; Tirado-Munoz, Judit; Fonseca, Francina; Farre, Magi; Gonzalez-Pinto, Ana; Arrojo, Manuel; Bernardo, Miquel; Arranz, Belen; Garriga, Marina; Saiz, Pilar A; Florez, Gerardo; Manuel Goikolea, Jose; Zorrilla, Inaki; Cunill, Ruth; Castells, Xavier; Becona, Elisardo; Lopez, Ana; San, Luis

Affiliations

CIBERSAM, Inst Invest Biomed August Pi i Sunyer IDIBAPS, Hosp Clin, Barcelona, Spain - Author

CIBERSAM, Parc Sanitari St Joan de Deu, Barcelona, Spain - Author

Complejo Hosp Ourense, Unidad Conductas Adict, CIBERSAM, Orense, Spain - Author

EOXI Santiago de Compostela, Serv Psiquiatria, Santiago De Compostela, Spain - Author

Hosp Badalona Germans Trias & Pujol, Clin Pharmacol Unit, Inst Recerca Germans Trias HUGTP IGTP, Badalona, Spain - Author

IMIM Inst Hosp del Mar Invest Med, Addict Res Grp, Barcelona, Spain - Author

NULL - Author

Univ Autonoma Barcelona UAB, RTA Barcelona, Barcelona, Spain - Author

Univ Basque Country, Hosp Univ, CIBERSAM, Inst Invest Sanitaria BIOARABA,OSI Araba, Vitoria, Spain - Author

Univ Girona, Dept Ciencias Med, Grp Invest TransLab, Girona, Spain - Author

Univ Oviedo, CIBERSAM, Inst Invest Sanitaria Principado Asturias ISPA, Serv Salud Principado Asturias SESPA, Oviedo, Spain - Author

Univ Santiago de Compostela, Fac Psicol, Unidad Tabaquismo & Trastornos Adict, Santiago De Compostela, Spain - Author

Abstract

Co-occurrence of depression and a substance use disorder (SUD) in patients who present dual diagnoses has been long recognized as an important consideration in clinical practice. This review synthesizes the evidence of pharmacological and psychosocial interventions for comorbid depressive disorders and SUDs while providing clinical recommendations about the best interventions to address these patients. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Our results suggest that 1) In patients with depression and alcohol consumption, the administration of non-selective serotonin reuptake inhibitor (SSRI) antidepressants instead of SSRI is recommended for improvement of depressive symptoms (strong recommendation). Neither SSRI (strong recommendation) nor non-SSRI (weak recommendation) antidepressants are recommended for reduction in alcohol consumption. 2) In patients with depression and cannabis use, the use of venlafaxine is not recommended (weak recommendation). 3) In patients with depression and cocaine consumption, the use of SSRI antidepressants for improving depressive symptoms (weak recommendation) or to reduce cocaine use is not recommended (strong recommendation). The use of non-SSRI antidepressants is only recommended for improving depressive symptoms (strong recommendation). 4) The administration of bupropion to reduce nicotine consumption is not recommended (strong recommendation). 5) Regarding psychological treatment, in patients with depression and co-occurring alcohol disorder, both pharmacotherapy and cognitive behavioural therapy have positive effects on internalizing symptoms and in reducing alcohol consumption (weak recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite evidence.

Keywords

alcoholalcohol-use disordersantidepressantscannabiscocainecognitive-behavioral therapydouble-blindimipramine treatmentmetaanalysisnefazodone treatmentnicotineplacebo-controlled trialselective serotonin reuptake inhibitorssertraline treatmentsmoking-cessationsubstance use disorderAdultAlcoholAlcoholismAntidepressant agentAntidepressantsAntidepressive agentsAnxietyAnxiety disorderAnxiety disordersBipolar disorderCannabisCocaineCocaine-dependent patientsComorbidityComplicationDepressionDesipramineDisulfiramDrug dependenceGroup therapyHumanHumansMetham-phetamineNaltrexoneNicotineParoxetinePosttraumatic stress disorderPsychostimulantPsychotherapy, groupSelective serotonin reuptake inhibitorsSerotonin uptake inhibitorSerotonin uptake inhibitorsSubstance useSubstance use disorderSubstance-related disorders

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Adicciones due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Medicine (Miscellaneous).

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.19. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

Field Citation Ratio (FCR) from Dimensions: 2.75 (source consulted: Dimensions Jul 2025)
Normalized Impact calculated by Dialnet Metrics: 1.11 (source consulted: Dialnet Metrics Dec 2023)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-16, the following number of citations: