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Major depression among methamphetamine users entering drug treatment programs

Med J Aust 2011; 195 (3): 51.

Summary

Objective: To determine the prevalence of major depression among people entering treatment for methamphetamine use.

Design, setting and participants: The study was a cross-sectional survey involving 41 specialised drug and alcohol treatment agencies in Brisbane and Sydney. Services provided by these agencies included residential rehabilitation, detoxification and counselling. Participants were 400 people entering treatment for methamphetamine use who were recruited from participating treatment agencies between January 2006 and November 2007. Participants underwent a structured, face-to-face, 1.5-hour interview. Assessment instruments included the Composite International Diagnostic Interview and the Short Form 12.

Main outcome measure: Diagnosis of a major depressive episode in the year prior to the study.

Results: The prevalence of major depression in the year prior to the study was 40% (95% CI, 35%–44%). A noteworthy post-hoc observation was that a further 44% of participants met the symptom criteria for major depression but were excluded from a diagnosis because their symptoms were better accounted for by psychoactive substance use. Both major depression and these latter cases of “substance-induced depression” were associated with severe symptoms of depression, high levels of disability and suicidal ideation.

Conclusion: Most people entering treatment programs for methamphetamine use have levels of depression that require clinical management. Making a diagnosis of major depression in the context of heavy methamphetamine use is problematic because of substance-induced symptoms of depression.

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  • Rebecca McKetin1,2
  • Daniel I Lubman3,4
  • Nicole M Lee5
  • Joanne E Ross2
  • Tim N Slade2

  • 1 Centre for Mental Health Research, Australian National University, Canberra, ACT.
  • 2 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW.
  • 3 Turning Point Alcohol and Drug Centre, Melbourne, VIC.
  • 4 Monash University, Melbourne, VIC.
  • 5 National Centre for Education and Training on Addiction, Flinders University, Adelaide, SA.


Acknowledgements: 

The data reported here were collected through the Methamphetamine Treatment Evaluation Study (MATES). The study was conducted by the National Drug and Alcohol Research Centre, University of New South Wales, and was funded by the National Health and Medical Research Council and the Australian Government Department of Health and Ageing. We acknowledge the contribution of the following MATES investigators: Robert Ali, Amanda Baker, Sharon Dawe, Richard Mattick, Abdullah Mamun and Jake Najman. We also thank the research officers who assisted with data collection (Shelley Cogger, Erin Kelly, Kate Hetherington, Grace Ho, Julia Rosenfeld, Cathie Sammut, Sagari Sarkar, Rachel Sutherland and Miriam Wyzenbeek), the participating treatment agencies, and the research participants.

Competing interests:

Rebecca McKetin has received consultancy fees from the United Nations Office on Drugs and Crime. Daniel Lubman has received speakers fees from Bristol-Myers Squibb (2007) and conference travel support from AstraZeneca and Janssen (2008). Nicole Lee has done paid consultancy work for St John of God Health Care.

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