Abstract
BackgroundMajor depressive disorder (MDD) and cocaine use disorder (CUD) are related with disability and high mortality rates. The assessment and treatment of psychiatric comorbidity is challenging due to its high prevalence and its clinical severity, mostly due to suicide rates and the presence of medical comorbidities. The aim of this study is to investigate differences in brain derived neurotrophic factor (BDNF) and cortisol plasmatic levels in patients diagnosed with CUD-primary-MDD and CUD-induced-MDD and also to compare them to a sample of MDD patients (without cocaine use), a sample of CUD (without MDD), and a group of healthy controls (HC) after a stress challenge.MethodsA total of 46 subjects were included: MDD (n = 6), CUD (n = 15), CUD-primary-MDD (n = 16), CUD-induced-MDD (n = 9), and 21 HC. Psychiatric comorbidity was assessed with the Spanish version of the Psychiatric Research Interview for Substance and Mental Disorders IV (PRISM-IV), and depression severity was measured with the Hamilton Depression Rating Scale (HDRS). Patients were administered the Trier Social Stress Test (TSST) before and after the biological measures, including BDNF, and cortisol levels were obtained.ResultsAfter the TSST, Cohen's d values between CUD-primary-MDD and CUD-induced-MDD increased in each assessment from 0.19 post-TSST to 2.04 post-90-TSST. Pairwise differences among CUD-induced-MDD and both MDD and HC groups had also a large effect size value in post-30-TSST and post-90-TSST. In the case of the BDNF concentrations, CUD-primary-MDD and CUD-induced-MDD in post-90-TSST (12,627.27 ± 5488.09 vs.17,144.84 ± 6581.06, respectively) had a large effect size (0.77).ConclusionResults suggest a different pathogenesis for CUD-induced-MDD with higher levels of cortisol and BDNF compared with CUD-primary-MDD. Such variations should imply different approaches in treatment.
Highlights
Mental and substance use disorders (SUD) are related with 7% of the global burden of disease as measured in disability-adjusted life years (DALYs) and increasing significant mortality rates [1]
The aim of this study is to investigate differences in brain derived neurotrophic factor (BDNF) and cortisol plasmatic levels in patients diagnosed with cocaine use disorder (CUD)-primary-major depression disorder (MDD) and CUD-induced-MDD and to compare them to a sample of MDD patients, a sample of CUD, and a group of healthy controls (HC) after a stress challenge
After the Trier Social Stress Test (TSST), Cohen’s d values between CUD-primary-MDD and CUD-induced-MDD increased in each assessment from 0.19 post-TSST to 2.04 post-90-TSST
Summary
Mental and substance use disorders (SUD) are related with 7% of the global burden of disease as measured in disability-adjusted life years (DALYs) and increasing significant mortality rates [1]. It is essential to distinguish between primary and induced MDD as they vary with respect to prognosis, relapse risk [7], and response to antidepressants [8]. Some longitudinal studies demonstrate that patients with an initial diagnosis of induced MDD after some years developed a primary one [10]. A number of studies and reviews indicate differences in response depending on the type of depression with worse response to serotonin selective reuptake inhibitors (SSRI) for induced MDD [11, 12]. Major depressive disorder (MDD) and cocaine use disorder (CUD) are related with disability and high mortality rates. The aim of this study is to investigate differences in brain derived neurotrophic factor (BDNF) and cortisol plasmatic levels in patients diagnosed with CUD-primary-MDD and CUD-induced-MDD and to compare them to a sample of MDD patients (without cocaine use), a sample of CUD (without MDD), and a group of healthy controls (HC) after a stress challenge
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