Table 3.
The Impact of Pharmacotherapy of Childhood-onset Mood or Psychotic Disorders on the Development of Substance Use Disorders
| Disorder | Study | Follow-up (years) | Subjects | Age and sex | Measure | Medication | Findings | Comments |
|---|---|---|---|---|---|---|---|---|
| Depressive Disorder | Curry et al. (2012) (Randomized Control Tx) | 5 Years |
N (total) = 192 N (depression no SUD) = 192 |
12–18-Year-olds 43.8% male |
Demographics, Duration of Index MDE, CDRS-R, RADS, SIQ-Jr., CGAS, Comorbidity for mental health disorders/SUD | Mental health Tx-CBT, FLX, combination of CBT and FLX, or placebo | Short-term MDD Tx significantly reduced the rate of subsequent drug use disorder but not AUD specifically. Twelve of 103 TADS treatment responders (11.6%) developed an SUD versus 22 of 89 nonresponders (24.7%) [χ2 (1, N = 192) = 5.38, OR = 2.49 [1.15–5.38], p- = 0.02]. |
Before depression Tx, greater involvement with alcohol or drugs predicted later AUD or SUD, as did older age (for AUD) and more comorbid disorders (for SUD) |
| Depressive Disorder | Carrà et al. (2019) (Retrospective cohort, National Registry) | Retrospective |
N (total) = 391,753 N (youth depression) = 121,526 N (adult depression) = 270,227 |
12–17-Year-olds and 18+ 51.1% and 48.2% male respectively |
National Comorbidity Survey-Adolescent measured NMUPPR | Mental health Tx and/or substance use Tx | The likelihood of reports NMUPPRs among respondents who did not receive any Tx was higher for those with past year MDE. MDE risk ratio for youths who received some Tx (Mental Health or Substance Use Tx) was about 70–80% (ARR = 1.15, p < 001)) as compared with their UnTx counterpart (ARR = 1.57, p < 001) |
The analysis did not differentiate the type of Tx or describe details of Mental Health Tx |
| Bipolar Disorder | Goldstein et al. (2013) (Prospective longitudinal follow-up) | 4.25 Years |
N (total) = 167 N (bipolar no SUD) = 167 |
12–17 Years old % male not listed |
K-SADS, K-MRS | Psychotropic medications | Greater proximal use of Lithium (exposure in the preceding 12-week period) predicted lower likelihood of SUD development (HR: 0.99, 95% CI [0.97–1.00], p = 0.02). In contrast, use of antidepressants and any psychotropic medication other than Li had increased risk for developing SUD. |
Greater hypo/manic symptom severity in the preceding 12 weeks predicted greater likelihood of SUD onset |
| Psychotic Disorder | Turner et al. (2009) (Prospective longitudinal follow-up) | 2 Years |
N (total) = 236 N (psychotic features) = 236 |
16–30 Years old 72.5% male |
DSM-IV clinical diagnosis, substance use assessment, PANSS, GAF, duration of untreated psychosis before starting an antipsychotic, QLS, HoNOS | Low-dose atypical antipsychotics | Marginal reduction in SUD (16%, p < 0.10) in SUD from baseline in individuals who continued Tx versus those who stopped Tx. | Participants reported substance use, but not necessarily SUD |
| Psychotic Disorder | Petersen et al. (2007) (Uncontrolled open incidence cohort) | 2 Years |
N (total) = 547 N (schizophrenia spectrum) = 547 N (OPUS Tx) = 275 N (standard Tx) = 272 |
M = 25 years old 70.0% male |
SCAN, SAPS, SANS | Second generation antipsychotics | Multidisciplinary Tx reduced SUD (OR = 0.5; 95% CI [0.3–10], p = 0.05) and improved clinical outcome in the SUD group versus TAU (reduced hospitalized days (109 days vs. 167 days) | Evaluation of multidisciplinary team approach versus treatment as usual. Both groups received antipsychotics. |
CDRS-R, Children's Depression Rating Scale-Revised; CGAS, Children's Global Assessment Scale; CI, confidence interval; GAF, Global Assessment of Functioning; HoNOS, Health of the Nation Outcome Scale; HR, hazards ratio; K-MRS, Kiddie Mania Rating Scale; K-SADS, Schedule for the Assessment of Conduct, Hyperactivity, Anxiety, Mood; NMUPPR, Non-Medical Use of Prescription Pain Relievers; PANSS, Positive and Negative Syndrome Scale; OR, odds ratio; QLS, Quality of Life Scale; RADS, Reynolds Adolescent Depression Scale; SANS, Scale for Assessment of Negative Symptoms; SAPS, Scale for Assessment of Positive Symptoms; SCAN, Schedules for Clinical Assessment in Neuropsychiatry; SIQ-Jr, Suicidal Ideation Questionnaire-Jr. High Version; SUD, Substance Use Disorder; Tx, treatment; UnTx, untreated.