Outcome of Patients With High Depressive Symptoms on Admission to Methadone Maintenance Treatment

Objective: Comorbidity of depression among individuals with opioid addiction is highly prevalent, but their outcome in methadone maintenance treatment (MMT) is not well determined. Methods: Characteristics and outcomes (retention until December 2017) of newly admitted and already (5.5 +/- 4 years) in MMT patients with available Hamilton Depression Rating Scale (HAM-D) scores on admission were studied. Results: During psychiatric intake on admission, 70 (21.2%) of 330 patients were diagnosed with high depressive symptoms beyond the cutoff (HAM-D scores >= 18). Depressed and nondepressed groups had a similar proportion of females (20% and 23.8%) and age at admission (43.0 +/- 10.5 and 43.7 +/- 10.4 years), but the depressed group had higher Brief Psychiatric Rating Scale (BPRS) scores (21.4 +/- 8.6 vs. 7.0 +/- 7.3, respectively; p < .0005), a higher proportion of minority (non-Jewish faith; 28.6% vs.15.4%; p =.02), and a higher proportion of positive urine screening results for cocaine (55.7% vs. 34.4%; p = .001) and for benzodiazepines on admission (74.3% vs. 57.5%; p = .01). Retention after 1 year was similar (79% and 80.7%), but depressed patients had higher rates of cocaine (40.8% vs. 25.5%; p = .05) and benzodiazepine use (59.2% vs. 41.8%; p = .04) and a shorter cumulative retention (5.6 years, 95% confidence interval [CI; 4.3, 7.0]) than the nondepressed patients (6.8 years, 95% CI [6.1, 7.5]; p = .05). Of the 263 evaluated while already in MMT, 23.5% were depressed, characterized with more females (43.5% vs. 23.4%) and with a history of rape (34.5% vs. 7.6%). Conclusions: Newly admitted depressed and nondepressed patients succeeded similarly in the first year retention in treatment, despite their cocaine and benzodiazepine co-abuse. The depression was characterized with females and with rape history in those who were already in MMT. Adequate intervention is recommended for both depressed groups to improve long-term retention and outcome.