Adults with any AUD (mild, moderate, or severe) in the past 12 months have 1.2 (95% confidence interval 1.08 to 1.35) times the odds of having a major depressive disorder compared with adults without an AUD. ĪUDs and depressive disorders often co-occur.
Adults with an AUD are more likely than those without an AUD to have worse physical health, mental health, and social functioning, while depression is one of the leading causes of disease burden worldwide and is associated with significantly increased risks of morbidity and mortality. Best estimates of current rates (past 12 months) for noninstitutionalized populations indicate that 13.9% of adults meet criteria for an AUD, and 6.7% of adults meet criteria for a major depressive episode. Limitations include the sparsity of evidence on intervention effects over the long term, risks of attrition bias, and heterogeneous definitions of adverse events in the evidence base.Īlcohol use disorders (AUDs) and depressive disorders are prevalent behavioral health conditions among adult populations with significant personal, societal, and economic consequences. We have very low confidence in all other effect estimates, and we did not have high confidence in any effect estimates. However, we have moderate confidence that patients receiving SSRIs also were more likely to experience an adverse event (OR = 2.20 95% CI, 0.94 to 5.16, p = 0.07). Compared with placebo, we have moderate confidence that selective serotonin reuptake inhibitors (SSRIs) demonstrated greater benefit for functional status (SMD = −0.92 95% CI, −1.36 to −0.47, p < 0.001) and low confidence for alcohol use (SMD = −0.30 95% CI, −0.59 to −0.02, p = 0.039). We have low confidence that tricyclic antidepressants (TCAs) demonstrated greater benefit than placebo (SMD = −0.37 95% CI, −0.72 to −0.02, p = 0.038) for depressive symptoms. We have moderate confidence that cognitive behavioral therapies (CBTs) demonstrated greater benefit than no additional treatment (SMD = −0.84 95% confidence interval, −1.05 to −0.63 p < 0.001) for depressive symptoms and low confidence (SMD = −0.25 95% CI, −0.47 to −0.04 p = 0.021) for alcohol use. We have very low confidence in all estimates of intervention effects on our primary outcomes (i.e., remission from depression and remission from alcohol use). Studies were published from 1971 to 2019, conducted in 13 countries, and had a median sample size of 50 participants (range: 14 to 350 participants). Overall, 36 RCTs with 2,729 participants evaluated 14 pharmacological and 4 psychological interventions adjunctive to treatment as usual (TAU). We used standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes to estimate intervention effects. Secondary outcomes were depressive symptoms, alcohol use, heavy drinking, health-related quality of life, functional status, and adverse events. Primary outcomes were remission from depression and alcohol use. We assessed risk of bias using the Cochrane Risk of Bias tool, used frequentist random effects models for network meta-analyses, and rated our confidence in effect estimates using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
Two independent reviewers extracted study-level information and outcome data. We included randomized controlled trials (RCTs) evaluating clinical interventions for adults with co-occurring AUDs and depressive disorders.
We searched CINAHL,, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Excerpta Medica Database, International Clinical Trials Registry Platform (ICTRP), PubMed, PsycINFO, and Web of Science from inception to December 2020.
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