Association between improvement in depression, reduced benzodiazepine (BDZ) abuse, and increased psychotropic medication use in methadone maintenance treatment (MMT) patients

Abstract

We had evaluated the depressive symptoms severity of 75 former heroin addicts in methadone maintenance treatment (MMT) using the 21-item Hamilton rating scale for depression (21-HAM-D) and re-assessed 63 of them 1.6 ± 0.3 years later. The second mean 21-HAM-D score was lower than the first (11.8 ± 8.4 versus 17.4 ± 6.2, p < 0.0005). Benzodiazepine (BDZ) abuse was lower although not significantly ( p = 0.06) during the month preceding the second analysis (32/63, 50.8%) than the month preceding the first one (40/63, 63.5%). Psychotropic medication usage was higher at the second assessment than at the first one (50/63, 79.4% versus 27/63, 42.9%, p < 0.0005). 21-HAM-D score reduced significantly over time among 13 “no psychotropic medication” patients (13.5 ± 6.3 versus 6.8 ± 6.8, p = 0.005) and in 27 who started medication following the first assessment (19.3 ± 3.8 versus 11.0 ± 8.4, p < 0.0005), but not in those who were already taking any medication before the first assessment (17.7 ± 7.0 versus 15.0 ± 8.0, p = n.s). 21-HAM-D score reduced in all BDZ groups but scores were still highest in the 32 patients who continued BDZ abuse (19.4 ± 5.6 versus 15.2 ± 7.7) followed by 14 who stopped it (16.8 ± 6.4 versus 9.6 ± 9.1) and were lowest in 17 patients who never abused BDZ (14.2 ± 5.2 versus 7.2 ± 6.4) (repeated measured, time and group effect, each p < 0.0005). Predictors for being depressed at follow-up were pre-existing depression only. Stopping BDZ abuse and starting psychotropic treatment was associated with a reduction of depressive symptoms among MMT patients.