heroin and Depressive-Disorder

Recent clinical observations and psychiatric diagnostic findings of drug-dependent individuals suggest that they are predisposed to addiction because they suffer with painful affect states and related psychiatric disorders. The drugs that addicts select are not chosen randomly. Their drug of choice is the result of an interaction between the psychopharmacologic action of the drug and the dominant painful feelings with which they struggle. Narcotic addicts prefer opiates because of their powerful muting action on the disorganizing and threatening affects of rage and aggression. Cocaine has its appeal because of its ability to relieve distress associated with depression, hypomania, and hyperactivity.

Topics: Adult; Affective Symptoms; Aggression; Bipolar Disorder; Choice Behavior; Cocaine; Depressive Disorder; Heroin; Heroin Dependence; Humans; Male; Mental Disorders; Narcotics; Opioid-Related Disorders; Psychiatric Status Rating Scales; Psychoanalytic Theory; Rage; Self Medication

A sample of 15 patients participating in an injectable methadone trial and of 15 patients in an oral methadone maintenance treatment, who admitted injecting part or all of their methadone take-home doses, were compared to 20 patients in maintenance treatment who use methadone exclusively by mouth. The present study confirms the poorer general health, the higher levels of emotional, psychological or psychiatric problems, the higher use of illicit drugs, and the higher number of problems related to employment and support associated with the use of the intravenous mode of administration of methadone. As expected, due to the shunt of metabolism in the gut wall and of the liver first-pass effect, higher concentration to dose ratios of (R)-methadone, which is the active enantiomer, were measured in the intravenous group (23% increase). This difference reached an almost statistically significant value (P = 0.054). This raises the question whether the effect of a higher methadone dose could be unconsciously sought by some of the intravenous methadone users.

Topics: Administration, Oral; Adult; Brief Psychiatric Rating Scale; Depressive Disorder; Dose-Response Relationship, Drug; Employment; Female; Health Status; Heroin; Humans; Injections, Intravenous; Male; Methadone; Schizophrenia; Self Administration; Severity of Illness Index; Substance Withdrawal Syndrome; Substance-Related Disorders

This study tested the effectiveness of fluoxetine as a treatment for depression in a population of methadone-maintained opioid addicts. Methadone-maintained opioid addicts (44) with depression received fluoxetine or placebo in addition to their methadone, in a double-blind randomized trial, for 12 weeks. Depressive symptoms decreased significantly overall with no significant differences between the groups treated with fluoxetine versus placebo. In addition, drug use outcomes, including cocaine and heroin self-reported use and urine toxicology were measured. There was a significant decrease in heroin use in treatment, but no medication effect. Cocaine use, was unchanged from pre-treatment to endpoint. In separately analyzing data for the subsample of subjects with the most severe depression, there was a significant decrease in depression during treatment and a significant decrease in self-reported cocaine use, but no medication effect on either depressive symptoms or on cocaine use. This study suggests that fluoxetine is not an effective agent in treating depression or cocaine use in this population.

Topics: Adult; Antidepressive Agents, Second-Generation; Behavior, Addictive; Cocaine; Cocaine-Related Disorders; Depression; Depressive Disorder; Double-Blind Method; Female; Fluoxetine; Heroin; Humans; Male; Methadone; Narcotics; Opioid-Related Disorders; Substance Abuse Detection; Treatment Outcome

Benzodiazepine (BZD) use is widespread among opioid-maintained patients worldwide. We conducted a cross-sectional survey to investigate motives and patterns of BZD use and psychiatric comorbidity in a convenience sample of patients (n=193) maintained on oral opioid agonists or diacetylmorphine (DAM). Prolonged BZD use and high-risk behaviors like parenteral use were common. After principal component analysis, motives were divided into those related to negative affect regulation, positive affect regulation (i.e. reward-seeking) and somato-medical problems. Negative affect regulation and somato-medical motives were associated with prolonged use. Psychiatric comorbidity was associated with several self-therapeutic motives, most importantly to lose anxiety. Patients maintained on DAM were more likely to be ex-users of BZD and report high positive affect regulation. Therefore, patients maintained on different agonists may have deviating motives for BZD use, which could be of importance when addressing this issue. Treatment of psychiatric comorbidity, in particular anxiety, depressive and sleeping disorders, may be helpful in reducing BZD use, particularly in patients maintained on oral opioids.

Topics: Adult; Analgesics, Opioid; Anxiety Disorders; Benzodiazepines; Depressive Disorder; Epidemiologic Methods; Female; Heroin; Humans; Male; Middle Aged; Motivation; Opiate Substitution Treatment; Prescription Drug Misuse; Self Medication; Sleep Initiation and Maintenance Disorders; Substance-Related Disorders; Young Adult

The objective of this study was to explore the characteristics of comorbid psychiatric symptoms and the relationship between different routes of drug administration and psychiatric symptoms. Five hundred and nine heroin addicts were studied in Drug Detoxification and Rehabilitation Centers in Yunnan and Heilongjiang provinces of China. The measure instrument, including demographic characteristics, history of drug abuse, and the Symptom Checklist-90 (SCL-90) scale (Chinese version), was administered to eligible heroin addicts. Among the subjects, comorbid psychopathology conditions were more severe on all dimensions of SCL-90 comparing with normal adults and the average score of Depression was highest among the 9 dimensions in heroin addicts; psychiatric symptoms were more severe in heroin injecting group than in "chasing the dragon" group and only the difference in Obsessive-Compulsive was significant, but more significant differences were found between snorting heroin addicts and chasing or injecting heroin addicts, and the average score of each dimension of SCL-90 was higher in the snorting group than in the other 2 groups. The reasons of the results and meaning for the present study are discussed. In summary, comorbid psychiatric symptoms in the heroin addicts were very common and severe and their severity varied with different routes of drug administration, suggesting that routes of drug administration should be considered as an important risk factor to mental health of heroin addicts.

Topics: Adult; Analysis of Variance; China; Comorbidity; Depressive Disorder; Diagnosis, Dual (Psychiatry); Female; Heroin; Heroin Dependence; Humans; Male; Mental Disorders; Psychiatric Status Rating Scales; Substance Abuse, Intravenous

Methadone maintenance treatment (MMT) has elevated rates of co-morbid memory deficit and depression that are associated with higher relapse rates for substance abuse. White matter (WM) disruption in MMT patients have been reported but their impact on these co-morbidities is unknown. This study aimed to investigate changes in WM integrity of MMT subjects using diffusion tensor image (DTI), and their relationship with history of heroin and methadone use in treated opiate-dependent individuals. The association between WM integrity changes from direct group comparisons and the severity of memory deficit and depression was also investigated. Differences in WM integrity between 35 MMT patients and 23 healthy controls were evaluated using DTI with tract-based spatial statistical analysis. Differences in DTI indices correlated with diminished memory function, Beck Depression Inventory, duration of heroin use and MMT, and dose of heroin and methadone administration. Changes in WM integrity were found in several WM regions, including the temporal and frontal lobes, pons, cerebellum, and cingulum bundles. The duration of MMT was associated with declining DTI indices in the superior longitudinal fasciculus and para-hippocampus. MMT patients had more memory and emotional deficits than healthy subjects. Worse scores in both depression and memory functions were associated with altered WM integrity in the superior longitudinal fasciculus, para-hippocampus, and middle cerebellar peduncle in MMT. Patients on MMT also had significant WM differences in the reward circuit and in depression- and memory-associated regions. Correlations among decreased DTI indices, disease severity, and accumulation effects of methadone suggest that WM alterations may be involved in the psychopathology and pathophysiology of co-morbidities in MMT.

Topics: Adult; Anisotropy; Brain; Brain Mapping; Depressive Disorder; Diffusion Tensor Imaging; Female; Heroin; Heroin Dependence; Humans; Male; Memory; Methadone; Middle Aged; Nerve Fibers, Myelinated; Neuropsychological Tests; Prospective Studies; Young Adult

Nonfatal heroin overdoses and suicide attempts are both common among heroin addicts, but there is limited knowledge about the association between them. The sample in the present study consisted of 149 regular heroin users in Malmö, Sweden. Out of these 98 had taken an unintentional heroin overdose at some time and 51 had made at least one attempt to commit suicide (but not using heroin). Suicide attempts were significantly more common among those who had taken unintentional overdoses as compared with those who had never taken any overdose (p < 0.01). The more overdoses, the greater the risk of suicide attempt.

Topics: Adult; Comorbidity; Depressive Disorder; Drug Overdose; Female; Heroin; Heroin Dependence; Humans; Male; Needle-Exchange Programs; Recurrence; Risk Factors; Substance Abuse Treatment Centers; Suicide, Attempted; Sweden

The relative and combined health effects of cigarette smoking, heroin use, and depression were examined in 322 clinically depressed smokers and 117 opioid-dependent smokers participating in two studies of the San Francisco Treatment Research Center. Opioid-dependent smokers averaged 16 years (S.D.=9) of heroin use; 3% of depressed smokers used opiates in the past 6 months. Cigarettes per day (M=15, S.D.=10) and Beck Depression (BDI-II) scores (M=21, S.D.=11) were comparable between the two groups. Health functioning was assessed using the Medical Outcomes Study Short Form (SF-36). Adjusting for demographic differences, depressed smokers reported better physical but poorer emotional health relative to opioid-dependent smokers. Both groups scored significantly lower than published norms (p<.05). Within groups, severity of depressive symptoms, tobacco use, and opiate use were independent predictors of lower health functioning (p<.05). Examining risk-related subgroups based on depression scores (BDI-II> or =20), cigarettes per day (> or =1 pack), and opiate use, number of risk factors was monotonically related to health functioning in both samples. Individuals with two or more risk factors scored the lowest (p<.05). Severity of depressive symptoms, tobacco use, and opiate use contributed individually and collectively to lower health functioning. Blended treatments that target multiple risk factors are needed to improve health outcomes.

Topics: Adult; Comorbidity; Depressive Disorder; Female; Health Status; Health Status Indicators; Heroin; Humans; Male; Nicotiana; Opioid-Related Disorders; Risk Factors; San Francisco; Smoking; Tobacco Use Disorder

A cohort of 495 heroin users, recruited for the Australian Treatment Outcome Study (ATOS), were re-interviewed at 12 months regarding suicide attempts over the follow-up period. The proportion who had attempted suicide in the 12 months since baseline was not significantly different from that reported in the 12 months preceding ATOS enrolment (12.2% versus 9.1%), and attempted suicide did not decline significantly in any of the index treatment groups. Among males, there was no significant reduction in attempted suicide (8.7% versus 8.1%). Among females, however, the proportion reporting an attempt declined significantly from 19.7 to 9.8%. Of those who reported suicidal ideation at baseline, 22.8% made an attempt over the follow-up period, as did 19.0% of those who had major depression. Large, and significant, declines in suicidal ideation (23.1% versus 6.9%) and major depression (25.5% versus 10.9%) occurred over the study period. Independent predictors of a suicide attempt over the follow-up period were: social isolation, having made an attempt in the preceding 12 months, suicidal ideation at baseline, a greater number of treatment episodes and higher levels of baseline polydrug use.

Topics: Adolescent; Adult; Analysis of Variance; Australia; Depressive Disorder; Female; Follow-Up Studies; Heroin; Heroin Dependence; Humans; Male; Middle Aged; Risk Factors; Sex Factors; Social Isolation; Substance Abuse Treatment Centers; Substance Abuse, Intravenous; Suicide, Attempted

To investigate the possible causes of unexplained hemorrhage into the neck musculature in deaths due to drowning, all cases of drowning between the years 1985 and 1995 examined by members of the Department of Forensic Pathology, University of Sheffield were reviewed. Cases were selected in which hemorrhage was found within the neck musculature but in which no apparent explanation for the hemorrhage, such as compression of the neck or trauma, was present. Eight cases were identified from a total of 99 deaths from drowning. Postmortem hypostasis was distributed in the back or diffusely in 6 cases and in the face in 3 cases. The degree of decomposition varied but was severe in only 1 case. A raised blood alcohol level was detected in 3 cases. Anterior neck compartment hemorrhage is probably due to hypostasis in a high proportion of cases. The Prinsloo and Gordon artifact may be an operative factor in at least some cases. Hemorrhage may result from violent neck movements during the process of drowning. Apparent "bruising" of the neck musculature does not always indicate compression of or trauma to the neck.

Topics: Adult; Aged; Aged, 80 and over; Depressive Disorder; Drowning; Ethanol; Hemorrhage; Heroin; Humans; Middle Aged; Muscular Diseases; Neck Muscles; Prevalence

Substance abuse is associated diagnostically with existing depression, pathological mourning of the traumatic event itself, with the inevitable experience of object loss, and loss of love. Inability to form object representation insures primitive lack of object constancy, resulting in pre-oedipal longing and neediness and malignant affect. Ambivalence towards the sadistic love objective is recognized and allows for a healthier, more complete period of mourning (Freud, 1917). Indeed, depression is banished from family acknowledgement in the service of homeostatic denial. This only reinforces the identified patient's feeling of unreality, shame and guilt over verbalizing the depression and the frequent underlying traumatic history. The enormous role of socio-economic stress is pervasive, yet the focus here is on individuals with complex dynamic constellations which are often ignored in the face of external factors. Addiction as attempt to self-medicate depression and trauma remains the overarching theme.

Topics: Adult; Depressive Disorder; Female; Heroin; Humans; Psychoanalytic Therapy; Substance Withdrawal Syndrome; Substance-Related Disorders

Residents in a detoxification/motivation program for drug users provided speech samples just after detoxification and again 5 weeks later. Content analysis scales were used to obtain scores for Hostility (Inward, Outward, and Ambivalent), Cognitive Anxiety, Pawn, Origin, and Sociality. Comparisons were made with scores from a previous sample of students, unemployed people, and drug users. At the end of the program there were significant positive changes in all scores except those for Hostility Outward and Pawn. Of particular interest was the anger expressed just after detoxification and maintained at a significantly high level during the following weeks. This suggests a need for drug-treatment programs to include specific anger-management interventions.

Topics: Adaptation, Psychological; Adolescent; Adult; Anger; Anxiety Disorders; Depressive Disorder; Female; Heroin; Heroin Dependence; Hospital Units; Humans; Interview, Psychological; Male; New South Wales; Substance Withdrawal Syndrome

Topics: Adolescent; Alcoholism; Barbiturates; Black People; Connecticut; Depression; Depressive Disorder; Geriatrics; Heroin; Meperidine; Morphine Dependence; Neurotic Disorders; Social Conditions; Statistics as Topic; Substance-Related Disorders