Effects of Major Depression on Remission and Relapse of Substance Dependence

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Abstract
MAJOR DEPRESSIVE disorder (MDD) is common among substance abusers1-5 and associated with considerable psychosocial disability,6-8 suggesting that MDD may impede long-term remission from drug and alcohol dependence. Diagnostic problems have complicated research in this area, with efforts to resolve them largely relying on the temporal sequencing of depressive symptoms relative to substance abuse. In DSM-IV,9 major depression is "primary" if "not due to the physiological effects of a substance," a causal relationship inferred largely from timing. Primary MDD is diagnosed when symptoms precede substance use or persist during extended periods of abstinence. A DSM-IV substance-induced disorder is diagnosed when clinically significant symptoms co-occur with substance use but clearly exceed the expected effects of intoxication or withdrawal. Little prospective research is available on whether these aspects of timing affect the course of substance dependence or whether primary episodes starting prior to the lifetime onset of substance use have different effects from primary episodes occurring during periods of abstinence.