Magazine article Clinical Psychiatry News

Treat Comorbid Depression, SUD Simultaneously

Magazine article Clinical Psychiatry News

Treat Comorbid Depression, SUD Simultaneously

Article excerpt

EXPERT ANALYSIS FROM THE AACAP ANNUAL MEETING

SAN DIEGO -- Adolescents with substance abuse and depression should be simultaneously treated for both conditions--and preferably by the same provider or clinical team, said Dr. Paula Riggs, professor of psychiatry and director of the division of substance dependence at the University of Colorado at Denver, Aurora.

"It's hard to be successful in drug treatment under the best of circumstances. If you have an untreated Axis I mental health disorder, it's not going to go well," said Dr. Riggs, who is an expert in treating comorbid adolescent substance abuse and psychiatric disorders.

"Adolescent depressions usually do not remit with abstinence" from drugs and alcohol, Dr. Riggs said at the annual meeting of the American Academy of Child and Adolescent Psychiatry. "If you have a kid walk through your door with depression and SUD [substance abuse disorder], treating the SUD won't make the depression go away. Once you've got both, you've got two things you've got to address."

Successful treatment of childhood depression does reduce the risk of later substance abuse, especially if the depression remits within 12 weeks of starting treatment, said Dr. Riggs. "But the converse is not true," she said.

About 25%-50% of adolescents who present for mental health treatment meet criteria for SUDs, Dr. Riggs said. And more than half of preteens with mental health problems are at risk for developing a SUD by the time they reach adolescence, she said. "By and large, psychiatric problems are pediatric-onset illnesses, and we know from ample research that most adults who suffer from addiction started using when they were adolescents," she added. But all too often, teens with comorbid SUD and Axis I disorders go without treatment, Dr. Riggs said.

In a recent pooled analysis of 2,111 adolescents with comorbid major depression and SUD, 48% were treated for depression and 10% received help for substance abuse, she noted. Furthermore, being in the juvenile justice system was the strongest predictor of dual treatment. "I don't know why people aren't up in arms about that," she said. "We kind of require kids to fall in the hole to get treatment. …

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