Medications

Compared with behavioral treatments, a somewhat larger body of work exists that examines medications to treat depression in SUD patients, including a meta-analysis (Nunes and Levin, 2004) and a recent review (Tiet and Mausbach, 2007). Nunes and Levin (2004) identified 14 studies from 300 studies examining the issue of treating depression with medication in SUD patients. Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) were the most common agents examined. Of the 14 studies, 57 percent (n = 8) reported a modest effect of medications to treat depression in this population. The pooled effect size from the random-effects model was 0.38 (95 percent CI = 0.18–0.58). The results appeared to be more robust in alcohol-dependent patients than drug-dependent patients. It should be noted that the heterogeneity of effects on the measure of depression (HRSD) was significant (p < 0.02) and related to the placebo response.

Overall, the results suggested that when medication effectively treats depression, it also appears to help reduce the use of substances (Nunes and Levin, 2004). The SSRIs were concluded to be first-line medications based on their tolerability and low toxicity relative to tricyclic antidepressants. The review concluded that existing treatments for reducing depressive symptoms also work in depressed SUD patients, and efficacious treatments of SUDs also reduce substance use in depressed SUD patients. However, the efficacy of integrated treatments remains uncertain given the limited data in this area and the methodological challenges that limit confidence in strong conclusions from the existing data (Tiet and Mausbach, 2007). Knowledge is clearly lacking in the interaction that depression medications and substance use may have on patients. While recent research is focused on developing and examining behavioral and pharmacotherapies in depressed SUD patients, to the best of our knowledge no studies have examined these interventions specifically in parents with depression and SUDs or examined the parenting outcomes that these treatments may help improve. Furthermore, while effective treatments exist for depressed patients with SUD comorbidities, the current systems of SUD treatment and mental health treatment often operate in parallel rather than in integration, making optimal care a continuing challenge (Quello, Brady, and Sonne, 2005).

VULNERABLE POPULATIONS

Low-Income and Minority Mothers

The impact of treatment interventions and, more specifically, collaborative care models on parental depression has not been rigorously studied



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