The Canadian Journal of Psychiatry

Bahji, Anees; Tang, Victor; Danilewitz, Marlon

doi: 10.1177/07067437251374564pmid: 40900104

Co-occurring alcohol use disorder (AUD) and major depressive disorder (MDD) are common and complex conditions that significantly impact patient outcomes. The bidirectional relationship between alcohol use and depression complicates diagnosis and treatment, as alcohol exacerbates depressive symptoms and vice versa. Integrated treatment addressing both disorders simultaneously has shown better outcomes compared to sequential treatments. This article provides evidence-based clinical guidance for managing patients with co-occurring AUD and MDD, focusing on pharmacotherapy, psychotherapy and integrated care models. Pharmacologically, selective serotonin reuptake inhibitors and tricyclic antidepressants are commonly used to treat depression in individuals with AUD, while naltrexone and acamprosate are first-line medications for AUD. Combining antidepressants with AUD medications improves treatment efficacy. Psychotherapeutic interventions such as Cognitive-Behavioural Therapy (CBT) and Motivational Interviewing are essential components of treatment, focusing on addressing both alcohol use and depressive symptoms. Behavioural activation has also proven effective in treating depression while reducing alcohol cravings. Integrated care models, where both disorders are addressed simultaneously, yield the best outcomes and involve coordinated pharmacotherapy, psychotherapy and ongoing follow-up care. A case example of a 33-year-old woman with AUD and MDD highlights the success of an integrated treatment approach, where a combination of sertraline, naltrexone and CBT led to significant improvements in both mood and alcohol use. Clinicians are advised to differentiate between alcohol-induced depression and primary MDD, consider potential medication interactions, and incorporate ongoing psychotherapy and monitoring for optimal patient outcomes. This approach emphasizes the importance of addressing both conditions concurrently to achieve better long-term recovery outcomes for patients with co-occurring AUD and MDD.

Hendershot, Christian S.; Le Foll, Bernard

doi: 10.1177/07067437241307902pmid: 39763227

Oprea, Anna; Steinman, Joe; Huang, Grace; Soyinka, Omolara; Brookbank, Megan; Abesteh, James; Hartman, Maya; McEvoy, Alannah; Dionne, Joanna C.; Milev, Roumen; Samaan, Zainab

doi: 10.1177/07067437251394369pmid: 41308055

ObjectiveThe effectiveness of current treatment options for depressive symptoms has been widely investigated with acknowledgment that some patients were either not adequately responding to treatment, finding the existing treatment intolerable, or otherwise prefer alternative options. There is increasing interest in microbiota modulation as an alternate form of depression treatment, with a growing number of trials and reviews on the subject published in the last five years. This systematic review aimed to analyze all completed randomized control trials (RCTs) that assessed depression symptoms in adults not using antidepressants, before and after oral methods of microbiota manipulation.MethodAll completed parallel-arm RCTs that assessed depression symptoms in adult participants before and after oral methods of microbiota manipulation were retrieved from four databases, MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials. Data on study and intervention characteristics as well as RCT conclusions were collected independently and in duplicate, and each study's findings were summarized individually. Risk of bias was completed.ResultsWe included 66 RCTs in our review, 34 of which concluded significant differences between the intervention and control group in depressive symptom using different interventions and measures. Of the 66 trials, 54 used probiotic interventions, seven used prebiotic, eight used synbiotic and two used oral fecal microbiota transplantation. Wide variation was observed in studies’ design, intervention composition and consumption methods across all 66 RCTs. No statistical synthesis or meta-analyses were possible due to the wide variety of interventions, measures and outcomes.ConclusionsThe heterogeneity of the existing RCTs did not allow for concrete conclusions on whether oral microbiota manipulation interventions are viable alternative treatment options for adults experiencing depression symptoms. We encourage the development of standardized guidelines for the design and reporting of microbiota studies in depression for the possibility of future intervention efficacy testing.