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The influence of depression on treatment for methamphetamine use

Frances J Kay-Lambkin, Amanda L Baker, Nicole M Lee, Linda Jenner and Terry J Lewin
Med J Aust 2011; 195 (3 Suppl): S38.

Summary

Objective: To determine whether the presence of comorbid depression influences response to psychological treatment for methamphetamine use.

Design: Randomised controlled clinical trial.

Setting and participants: Our study was conducted between 2001 and 2005 at two sites in Australia: the Hunter Region of New South Wales and the city of Brisbane, Queensland. The 214 participants, who were all using methamphetamine at least once a week in the month prior to the study, were self-referred or referred from health services or drug and alcohol clinical services. Participants were divided into two groups based on whether or not they had depressive symptoms at baseline.

Interventions: The control group received only a self-help booklet; the two treatment groups received either two or four counselling sessions involving cognitive behaviour therapy and motivational interviewing techniques to manage methamphetamine use.

Main outcome measures: Changes in methamphetamine use and depression at 5 weeks and 6 months after baseline.

Results: Over 70% of participants met criteria for depression at baseline, and depression was associated with significantly greater severity of methamphetamine use and related issues. Benzodiazepine use was significantly higher among depressed than non-depressed participants. Reductions in methamphetamine use between baseline and 5 weeks were independently predicted by comorbid depression, in favour of increased change among those with baseline depression. Depressed participants who received three or four counselling sessions showed a significant reduction in depression at 5 weeks. However, reductions in methamphetamine use and depression compared with baseline were no longer evident at 6 months.

Conclusions: Over the short term, comorbid depression did not negatively affect response to treatment, with some evidence of a dose–response treatment effect for reduction in depression. This was not maintained at 6 months, indicating that methamphetamine-focused treatment may not enable people with comorbid depression to make sustained improvement at the level of their counterparts without depression.

Trial registration number: ACTRN12611000355976.

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  • Frances J Kay-Lambkin1,2
  • Amanda L Baker2
  • Nicole M Lee3
  • Linda Jenner3
  • Terry J Lewin2

  • 1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW.
  • 2 Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, NSW.
  • 3 Turning Point Alcohol and Drug Centre, Melbourne, VIC.

Correspondence: f.kaylambkin@unsw.edu.au

Acknowledgements: 

Our research was supported in full by a grant from Australian Department of Health and Ageing. We wish to acknowledge the involvement of the study participants.

Competing interests:

None relevant to this article declared (ICMJE disclosure forms completed).

  • 1. Australian Institute of Health and Welfare. 2007 National Drug Strategy Household Survey: first results. Canberra: AIHW, 2008. (AIHW Cat. No. PHE 98; Drug Statistics Series No. 20.)
  • 2. Darke S, Kaye S, McKetin R, Duflou J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev 2008; 27: 253-262.
  • 3. Australian Bureau of Statistics. National Survey of Mental Health and Wellbeing: summary of results, 2007. Canberra: ABS, 2008. (ABS Cat. No. 4326.0.)
  • 4. Zweben JE, Cohen JB, Christian D, et al. Psychiatric symptoms in methamphetamine users. Am J Addict 2004; 13: 181-190.
  • 5. Hall W, Farrell M. Comorbidity of mental disorders with substance misuse. Br J Psychiatry 1997; 171: 4-5.
  • 6. Rawson RA, Huber A, Brethen P, et al. Status of methamphetamine users 2–5 years after outpatient treatment. J Addict Dis 2002; 21: 107-119.
  • 7. Kay-Lambkin FJ, Baker A, Lewin T. The “co-morbidity roundabout”: a framework to guide assessment and intervention strategies and engineer change among people with co-morbid problems. Drug Alcohol Rev 2004; 23: 407-424.
  • 8. Scott J, Dickey B. Global burden of depression: the intersection of culture and medicine. Br J Psychiatry 2003; 183: 92-94.
  • 9. Glasner-Edwards S, Mooney LJ, Marinelli-Casey P, et al. Identifying methamphetamine users at risk for major depressive disorder: findings from the methamphetamine treatment project at three-year follow-up. Am J Addict 2008; 17: 99-102.
  • 10. Baker A, Lee NK, Claire M, et al. Drug use patterns and mental health of regular amphetamine users during a reported “heroin drought”. Addiction 2004; 99: 875-884.
  • 11. Baker A, Lee NK, Claire M, et al. Brief cognitive behavioural interventions for regular amphetamine users: a step in the right direction. Addiction 2005; 100: 367-378.
  • 12. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio, Tex: Psychological Corporation, 1996.
  • 13. Dawe S, Loxton N, Hides L, et al. Review of diagnostic and screening instruments for alcohol and other drug use and other psychiatric disorders. 2nd ed. Canberra: Commonwealth of Australia, 2002.
  • 14. First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV-TR axis I disorders, research version, patient edition. New York: Biometrics Research, New York State Psychiatric Institute, 2001.
  • 15. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Text revision. Washington, DC: APA, 2000.
  • 16. Gossop M, Darke S, Griffiths P, et al. The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction 1995; 90: 607-614.
  • 17. Darke S, Hall W, Wodak A, et al. Development and validation of a multi-dimensional instrument for assessing outcome of treatment among opiate users: the Opiate Treatment Index. Br J Addict 1992; 87: 733-742.
  • 18. Baker A, Kay-Lambkin FJ, Lee NK, et al. A brief cognitive behavioural intervention for regular amphetamine users. Canberra: Department of Health and Ageing, 2003.
  • 19. Practice guideline for the treatment of patients with major depressive disorder (revision). American Psychiatric Association. Am J Psychiatry 2000; 157 (4 Suppl): 1-45.
  • 20. Patten SB, Williams JV, Love EJ. Self-reported depressive symptoms following treatment with corticosteroids and sedative-hypnotics. Int J Psychiatry Med 1996; 26: 15-24.
  • 21. Miller WR, Walters ST, Bennett ME. How effective is alcoholism treatment in the United States? J Stud Alcohol 2001; 62: 211-220.
  • 22. McNulty J, Kouimtsidis C. Outcomes of treatment interventions in drug abuse. Curr Opin Psychiatry 2001; 14: 201-205.

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