Trastorno por uso de cocaína y depresión: Cuando el diagnóstico clínico no es suficiente

Abstract

Antecedentes: El consumo de cocaína es un creciente problema de salud en todo el mundo. Además, los pacientes con trastorno por consumo de cocaína (TCC) presentan una alta comorbilidad con el trastorno depresivo mayor (TDM). Estos pacientes pueden presentar dos tipos de TDM: trastorno depresivo mayor primario (TDM-P) y trastorno depresivo mayor inducido por cocaína (TDM-IC). El objetivo de este estudio es evaluar las diferencias en la sintomatología depresiva (TDM-P vs. TDM-IC) en los pacientes con TCC para mejorar su tratamiento. Métodos: Se llevó a cabo un análisis secundario en una muestra transversal de 160 pacientes que presentaban TCC y algún TDM. La evaluación clínica, así como el diagnóstico diferencial entre TDM-P y TDM-IC, se realizó utilizando la entrevista PRISM. Resultados: Los hombres representaron el 80% de la muestra con una edad media de 38,61 años y el 64,5% sólo tenía estudios primarios. El diagnóstico de TDM-IC (61,3%) fue más frecuente que el de TDM-P (38,7%). Los pacientes con TDM-IC mostraron una edad de aparición más temprana para el TCC. El 79,4% de los pacientes cumplían criterios para otro trastorno por consumo de sustancias. Únicamente el criterio "Cambios en el peso o en el apetito" fue estadísticamente más prevalente (57,1%) en los pacientes con TDM-P.Conclusiones: Existen diferencias en el criterio "Cambios en el peso o en el apetito" entre TDM-P y TDM-IC. Se necesita más investigación a fin de obtener un diagnóstico diferencial entre los dos tipos de depresión y proporcionar un mejor tratamiento para los pacientes con TCC. Palabras clave: Patología dual; Trastorno por uso de cocaína; Trastornos relacionados con el uso de cocaína; Trastorno depresivo; Trastorno depresivo inducido. Background: Cocaine use is a growing global health problem and patients with cocaine use disorders (CUD) present several complications, including high rates of major depression. These subjects present two types of major depressive disorder (MDD): primary major depressive disorder (P-MDD) and cocaine-induced major depressive disorder (CI-MDD). To improve treatment, it is necessary to distinguish between both types. The aim of this study was to assess the differences in depressive symptomatology criteria (P-MDD vs CI-MDD) in CUD patients. Methods: Secondary data analysis was carried out with a cross-sectional sample of 160 patients presenting CUD and MDD. Clinical assessment was performed using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). A differential diagnosis was obtained between P-MDD and CI-MDD. Results: Menrepresented 80% of the sample, the mean age was 38.61 years, and 64.5% had elementary studies. CI-MDD diagnosis (61.3%) was more frequent than P-MDD (38.7%). There was a younger age of CUD onset in CI-MDD patients. In addition, 79.4% of the patients had another substance use disorder diagnosis. The criterion "Changes in weight or appetite" was more prevalent (57.1%) in P-MDD group. Conclusions:We found differences in the criterion "Changes in weight or appetite".Fur...

Alcohol Induced Depression: Clinical, Biological and Genetic Features

“…The high medical comorbidity found among AI-MD patients may explain this significant difference related to weight criteria [ 70 , 71 ] although we have not detected this association in our sample. Other authors have found different criteria between Primary and Induced depression associated with cocaine use disorder [ 72 ]; however, these authors found more “weight changes” in the primary depression group compared to induced depression group. In contrast, Primary MD patients met more criteria related to anhedonia, loss of concentration and recurrent thoughts of death.…”

The Tryptophan System in Cocaine-Induced Depression

“…In clinical practice, the co-occurrence of substance use hinders both the diagnosis of depressive symptoms and the differentiation between primary depressive and cocaine-induced episodes. Indeed, such a distinction could prove crucial in improving diagnostics and treatment, and therefore the prognoses [2,3]. Accordingly, there is a growing interest in putative biomarker research that enhances a better approach to this comorbid pathology.…”

Dysregulation of Plasma Growth Factors and Chemokines in Cocaine Use Disorder: Implications for Dual Diagnosis with Schizophrenia and Antisocial Personality Disorder in an Exploratory Study

“…Despite the elevated prevalence of psychotic and personality disorders, the predominant focus of studies within the context of cocaine has been on mood disorders, specifically major depression [ 5 , 42 ]. In particular, dual diagnosis with SCZ and APD exacerbates the severity of these disorders, such as difficulties in decision-making, and compromises the daily functioning of these patients, and complicates the course and treatment of CUD [ 43 ].…”

“…Cocaine is one of the most commonly used psychoactive substances in young adults, and its use increases the incidence of severe clinical complications, including a significant loss of efficacy of current psychopharmacological interventions [1,2]. Repeated use of cocaine can lead to cocaine use disorder (CUD), which is associated with an elevated prevalence of comorbid mental disorders [3][4][5]. The coexistence of substance use disorder and additional psychiatric disorders is referred to as dual diagnosis, and the most common comorbidities among individuals with CUD are mood disorders, anxiety, psychotic disorders, and personality disorders [6,7].…”