Abstract Objective: Depression is the most common psychiatric comorbidity among people with opioid use disorders (OUDs). However, whether and how comorbid depression is associated with the outcomes of opioid agonist therapy (OAT) remains poorly understood. The objective of this review was to identify and describe the association between depression and main outcomes (opioid use and treatment retention) of methadone and buprenorphine treatment among people with OUDs. Methods: A literature review was conducted by searching five electronic databases (MEDLINE, PubMed, Embase, Evidence-Based Medicine Reviews [EBMR], and Cumulative Index of Nursing and Allied Health Literature [CINAHL] Complete) from January 1970 to April 2019. Two independent reviewers screened titles and abstracts of the identified records by using pre-established eligibility criteria. Next, full texts were reviewed and studies that met inclusion criteria were selected. Finally, a descriptive synthesis of extracted data was performed. Results: In total, 12,296 records were identified and 18 studies that met inclusion criteria were retained. Of these, six studies reported reduced opioid use and seven reported increased opioid use during methadone or buprenorphine treatment. In addition, three studies reported an increased retention rate and four documented a decreased retention rate during methadone or buprenorphine treatment. The remaining studies did not find any significant association between depression and opioid use or treatment retention. Overall, the evidence did not demonstrate a consistent association between depression and outcomes of methadone or buprenorphine treatment. Conclusions: Although the inconsistent nature of the current evidence prohibited us from drawing definitive conclusions, we posit that the presence of depression among OUDs patients may not always predict negative outcomes related to retention and drug use during the course of OAT. Particularly, the hypothesis that adequate treatment of depression can improve treatment retention is promising and is in line with the call for increased efforts to provide integrated care for comorbid mental health disorders and addiction. Future studies with rigorous methodology are essential to better characterize the complex interplay between depression, OAT, and OUDs.

中文翻译：

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阿片类药物使用障碍患者的抑郁和美沙酮和丁丙诺啡治疗结果：文献综述

摘要 目的：抑郁症是阿片类药物使用障碍（OUDs）患者中最常见的精神疾病。然而，共病抑郁症是否以及如何与阿片类激动剂治疗 (OAT) 的结果相关仍然知之甚少。本综述的目的是确定和描述抑郁症与 OUD 患者美沙酮和丁丙诺啡治疗的主要结果（阿片类药物使用和治疗保留）之间的关联。方法：通过检索 1970 年 1 月至 2019 年 4 月的五个电子数据库（MEDLINE、PubMed、Embase、Evidence-Based Medicine Reviews [EBMR] 和 Cumulative Index of Nursing and Allied Health Documentation [CINAHL] Complete）进行文献综述。两个独立审查员使用预先确定的资格标准筛选了已识别记录的标题和摘要。接下来，审查全文并选择符合纳入标准的研究。最后，对提取的数据进行了描述性合成。结果：总共确定了 12,296 条记录，并保留了 18 项符合纳入标准的研究。其中，六项研究报告减少了阿片类药物的使用，七项研究报告了美沙酮或丁丙诺啡治疗期间阿片类药物的使用增加。此外，三项研究报告了在美沙酮或丁丙诺啡治疗期间保留率增加，四项研究记录了保留率下降。其余研究未发现抑郁症与阿片类药物使用或治疗保留之间存在任何显着关联。总体而言，证据并未证明抑郁症与美沙酮或丁丙诺啡治疗结果之间存在一致的关联。结论：尽管当前证据的不一致性质使我们无法得出明确的结论，但我们认为 OUD 患者中存在抑郁症可能并不总是预测与 OAT 过程中保留和药物使用相关的负面结果。特别是，抑郁症的充分治疗可以提高治疗保留率的假设是有希望的，并且符合加大努力为共存的精神健康障碍和成瘾提供综合护理的呼吁。未来采用严格方法的研究对于更好地描述抑郁症、OAT 和 OUD 之间复杂的相互作用至关重要。我们假设 OUD 患者中抑郁的存在可能并不总是预测与 OAT 过程中保留和药物使用相关的负面结果。特别是，抑郁症的充分治疗可以提高治疗保留率的假设是有希望的，并且符合加大努力为共存的精神健康障碍和成瘾提供综合护理的呼吁。未来采用严格方法的研究对于更好地描述抑郁症、OAT 和 OUD 之间复杂的相互作用至关重要。我们假设 OUD 患者中抑郁的存在可能并不总是预测与 OAT 过程中保留和药物使用相关的负面结果。特别是，抑郁症的充分治疗可以提高治疗保留率的假设是有希望的，并且符合加大努力为共存的精神健康障碍和成瘾提供综合护理的呼吁。未来采用严格方法的研究对于更好地描述抑郁症、OAT 和 OUD 之间复杂的相互作用至关重要。