Managing coexisting depression and substance use disorder: insights from clinical experience
8 affiliations
- 1Hertfordshire Medical School, University of Hertfordshire
- 2Department of Neuroscience, Imaging and Clinical Sciences, G. D’Annunzio University
- 3Department of Psychiatry, Medical University of Warsaw
- 4CRI Porto Ocidental, Instituto de Comportamentos Aditivos e Dependências (ICAD)
- 5Clínica do Quinto Andar
- 6Department for Addiction Diseases, Provincial Clinic Mauer
- 7Department of Neurosciences, Head-Neck and Chest, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- 8Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore
Abstract
Comorbid major depressive disorder (MDD) and substance use disorder (SUD) occur frequently and are challenging to manage. The negative impact of these co-occurring conditions on patient quality of life, functional ability, and mortality necessitates timely diagnosis and a multifaceted treatment approach. However, there are few evidence-based clinical guidelines for these co-occurring conditions, further adding to the complexity of treatment. Here, we provide our perspective on the management of MDD in the context of SUD using clinical evidence and our experience. Due to the chronic, relapsing nature of these disorders, long-term follow-up is required to continually assess treatment efficacy and make adjustments where needed. Antidepressants frequently used for MDD, such as selective serotonin reuptake inhibitors (SSRIs), may show variable effectiveness in patients with comorbid SUD, and antidepressant selection should be individualized according to the patient profile, disease characteristics, and type of substance being misused. Treatment options with different pharmacodynamic profiles include agomelatine, bupropion, and vortioxetine. Serotonin antagonist and reuptake inhibitors (SARIs), such as trazodone, may offer advantages in select patients, given their safety profile and potential to address depressive features commonly seen with SUD. Importantly, collaboration between a range of healthcare professionals to provide psychoeducation and pharmacological management, alongside social support that includes family, friends, and/or caregivers is needed for treatment success. Further studies specifically assessing treatments for comorbid MDD and SUD are required. In addition, training is needed to increase medical expertise and lessen stigma, which can contribute to sub-standard care.
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BibTeX
@article{schifano2026managing,
title = {{Managing coexisting depression and substance use disorder: insights from clinical experience}},
author = {Fabrizio Schifano and Giovanni Martinotti and Marcin Wojnar and Inês Homem de Melo and Christian Korbel and Gabriele Sani},
journal = {Frontiers in Psychiatry},
year = {2026},
month = oct,
doi = {10.3389/fpsyt.2026.1919720},
url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1919720/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Managing coexisting depression and substance use disorder: insights from clinical experience
AU - Fabrizio Schifano
AU - Giovanni Martinotti
AU - Marcin Wojnar
AU - Inês Homem de Melo
AU - Christian Korbel
AU - Gabriele Sani
PY - 2026
DA - 2026/10/28
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1919720
UR - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1919720/full
AB - Comorbid major depressive disorder (MDD) and substance use disorder (SUD) occur frequently and are challenging to manage. The negative impact of these co-occurring conditions on patient quality of life, functional ability, and mortality necessitates timely diagnosis and a multifaceted treatment approach. However, there are few evidence-based clinical guidelines for these co-occurring conditions, further adding to the complexity of treatment. Here, we provide our perspective on the management of MDD in the context of SUD using clinical evidence and our experience. Due to the chronic, relapsing nature of these disorders, long-term follow-up is required to continually assess treatment efficacy and make adjustments where needed. Antidepressants frequently used for MDD, such as selective serotonin reuptake inhibitors (SSRIs), may show variable effectiveness in patients with comorbid SUD, and antidepressant selection should be individualized according to the patient profile, disease characteristics, and type of substance being misused. Treatment options with different pharmacodynamic profiles include agomelatine, bupropion, and vortioxetine. Serotonin antagonist and reuptake inhibitors (SARIs), such as trazodone, may offer advantages in select patients, given their safety profile and potential to address depressive features commonly seen with SUD. Importantly, collaboration between a range of healthcare professionals to provide psychoeducation and pharmacological management, alongside social support that includes family, friends, and/or caregivers is needed for treatment success. Further studies specifically assessing treatments for comorbid MDD and SUD are required. In addition, training is needed to increase medical expertise and lessen stigma, which can contribute to sub-standard care.
SN - 1664-0640
ER -