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Addiction. 2009 Oct;104(10):1700-9. doi: 10.1111/j.1360-0443.2009.02672.x. Epub 2009 Aug 4.

Subtypes of major depression in substance dependence.

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  • 1Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT 06030-2103, USA.



This study evaluated features that differentiate subtypes of major depressive episode (MDE) in the context of substance dependence (SD). Design  Secondary data analysis using pooled data from family-based and case-control genetic studies of SD.


Community recruitment through academic medical centers.


A total of 1929 unrelated subjects with alcohol and/or drug dependence.


Demographics, diagnostic criteria for psychiatric and substance use disorders and related clinical features were obtained using the Semi-Structured Assessment for Drug Dependence and Alcoholism. We compared four groups: no life-time MDE (no MDE), independent MDE only (I-MDE), substance-induced MDE only (SI-MDE) and both types of MDE.


Psychiatric measures were better predictors of MDE subtype than substance-related or socio-demographic ones. Subjects with both types of MDE reported more life-time depressive symptoms and comorbid anxiety disorders and were more likely to have attempted suicide than subjects with I-MDE or SI-MDE. Subjects with both types of MDE, like those with I-MDE, were also more likely than subjects with SI-MDE to be alcohol-dependent only than either drug-dependent only or both alcohol- and drug-dependent.


SD individuals with both types of MDE have greater psychiatric severity than those with I-MDE only or SI-MDE only. These and other features that distinguish among the MDE subtypes have important diagnostic and potential therapeutic implications.

© 2009 The Authors. Journal compilation © 2009 Society for the Study of Addiction.

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