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Should antidepressants be prescribed to people with substance use issues? Therapeutics Initiative (University of British Columbia)
Description
Background: People with substance use disorders (SUDs), including alcohol use disorder (AUD), often experience symptoms such as anxiety, depression, and insomnia. These symptoms are often connected to the biological and social effects of substance use and withdrawal. Historically, treatment was conservative, guided by expected remission of symptoms following substance reduction or abstinence. However, prescribing of serotonergic antidepressants (SSRIs, SNRIs, SARIs) in this population has increased, despite limited evidence supporting their efficacy and the potential risks of worsening substance use. Aims: This Therapeutics Letter considers whether antidepressants should be prescribed to patients with SUDs, particularly AUD. Findings from systematic reviews suggest that commonly prescribed serotonergic antidepressants offer no significant improvement in psychological symptoms and some RCTs demonstrate worsening substance use outcomes. This Letter also highlights the underutilization of proven treatments for SUDs, such as psychological interventions and medications like acamprosate and varenicline. Recommendations: Clinicians are advised to avoid prescribing serotonergic antidepressants in patients with SUDs and concurrent mental health disorders. Rather, treatment should prioritize evidence-based pharmacological and non-pharmacological strategies for reducing or abstaining from substance use, which can often alleviate associated psychological symptoms. If an antidepressant is prescribed, despite lack of evidence for benefit, advise the patient of the evidence gap and monitor closely for increasing substance use. Shifting resources toward evidence-based therapies and patient support systems could improve outcomes in this population.
Item Metadata
| Title |
Should antidepressants be prescribed to people with substance use issues?
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| Alternate Title |
Avoid serotonergic antidepressants for people with alcohol and other substance use disorders; Therapeutics Letter 152
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| Creator | |
| Date Issued |
2025-01
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| Description |
Background: People with substance use disorders
(SUDs), including alcohol use disorder (AUD), often
experience symptoms such as anxiety, depression,
and insomnia. These symptoms are often connected to
the biological and social effects of substance use and
withdrawal. Historically, treatment was conservative,
guided by expected remission of symptoms following
substance reduction or abstinence. However, prescribing
of serotonergic antidepressants (SSRIs, SNRIs, SARIs) in
this population has increased, despite limited evidence
supporting their efficacy and the potential risks of
worsening substance use.
Aims: This Therapeutics Letter considers whether
antidepressants should be prescribed to patients
with SUDs, particularly AUD. Findings from systematic
reviews suggest that commonly prescribed serotonergic
antidepressants offer no significant improvement in
psychological symptoms and some RCTs demonstrate
worsening substance use outcomes. This Letter also
highlights the underutilization of proven treatments
for SUDs, such as psychological interventions and
medications like acamprosate and varenicline. Recommendations: Clinicians are advised to avoid
prescribing serotonergic antidepressants in patients
with SUDs and concurrent mental health disorders.
Rather, treatment should prioritize evidence-based
pharmacological and non-pharmacological strategies
for reducing or abstaining from substance use, which
can often alleviate associated psychological symptoms.
If an antidepressant is prescribed, despite lack of evidence for benefit, advise the patient of the evidence
gap and monitor closely for increasing substance use.
Shifting resources toward evidence-based therapies
and patient support systems could improve outcomes
in this population.
|
| Subject |
Alcohol Use Disorder; Antidepressive Agents; Anxiety; Cannabis Use Disorder; Cocaine-Related Disorders; Depression; Mental Disorders; Selective Serotonin Reuptake Inhibitors; Serotonin and Noradrenaline Reuptake Inhibitors; Serotonin Antagonists; Sleep Initiation and Maintenance Disorders; Substance-Related Disorders; Substance Withdrawal Syndrome; Tobacco Use Disorder; Trazodone
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| Geographic Location | |
| Genre | |
| Type | |
| Language |
eng
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| Notes |
The UBC TI is funded by the BC Ministry of Health to provide evidence-based information about drug therapy. We neither formulate nor adjudicate provincial drug policies.
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| Date Available |
2025-05-07
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| Provider |
Vancouver : University of British Columbia Library
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| Rights |
Attribution-NonCommercial-NoDerivatives 4.0 International
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| DOI |
10.14288/1.0448774
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| URI | |
| Affiliation | |
| Peer Review Status |
Reviewed
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| Scholarly Level |
Faculty; Researcher
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| Rights URI | |
| Aggregated Source Repository |
DSpace
|
Item Media
Item Citations and Data
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International