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Duncan Z, Ward B, Kippen R, Dietze P, Sutton K. A narrative systematic review of associations and temporality between use of methamphetamine, ecstasy/MDMA, or cocaine with anxiety or depressive symptoms. Addict Behav 2024; 153:107988. [PMID: 38394960 DOI: 10.1016/j.addbeh.2024.107988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE Anxiety and depression are prevalent mental health problems in people who use illicit stimulants. Improved understanding of the temporal relationship between methamphetamine, ecstasy/MDMA, or cocaine use with anxiety or depression informs public health interventions and treatment options for those experiencing this co-occurrence. This narrative systematic review sought to examine associations and temporality between the use of methamphetamine, ecstasy/MDMA, or cocaine, with anxiety or depressive symptoms. Method Systematic searches of 4 electronic databases were conducted up to August 2023. Study eligibility included the measurement of anxiety and/or depressive symptoms, and frequency of illicit stimulant use (methamphetamine, cocaine, or ecstasy/MDMA) at two separate time points, with data analysis of the association between these variables. The Joanna Briggs Critical Appraisal Checklist was utilised to assess quality. Data was extracted, and a narrative synthesis incorporating an eight-criteria framework to assess associations was conducted. Results 4432 studies were screened for eligibility; 11 studies (3 RCTs and 8 prospective cohort studies) were included. Evidence for an association between depressive symptoms and methamphetamine use was demonstrated in six studies, with temporal evidence in three studies supporting methamphetamine use preceding depressive symptoms. Three studies reported an association between cocaine use and depressive symptoms. Evidence for associations with any of the illicit stimulants and anxiety symptoms was lacking. CONCLUSIONS There was some evidence to support a case for temporality, particularly for methamphetamine use and depressive symptoms. Investing in longitudinal studies is pivotal to understanding the dynamic and reciprocal relationship between illicit stimulant use and anxiety or depressive symptoms. A limitation of the study was the variation in the measurement and analysis of outcomes.
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Affiliation(s)
- Zoe Duncan
- Monash Rural Health, Monash University, Melbourne, Australia.
| | - Bernadette Ward
- Monash Rural Health, Monash University, Melbourne, Australia; Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Rebecca Kippen
- Monash Rural Health, Monash University, Melbourne, Australia
| | - Paul Dietze
- Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia; National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Keith Sutton
- Monash Rural Health, Monash University, Melbourne, Australia; National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia
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Substance use, microbiome and psychiatric disorders. Pharmacol Biochem Behav 2022; 219:173432. [PMID: 35905802 DOI: 10.1016/j.pbb.2022.173432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/29/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022]
Abstract
Accumulating evidence from several studies has shown association between substance use, dysregulation of the microbiome and psychiatric disorders such as depression, anxiety, and psychosis. Many of the abused substances such as cocaine and alcohol have been shown to alter immune signaling pathways and cause inflammation in both the periphery and the central nervous system (CNS). In addition, these substances of abuse also alter the composition and function of the gut microbiome which is known to play important roles such as the synthesis of neurotransmitters and metabolites, that affect the CNS homeostasis and consequent behavioral outcomes. The emerging interactions between substance use, microbiome and CNS neurochemical alterations could contribute to the development of psychiatric disorders. This review provides an overview of the associative effects of substance use such as alcohol, cocaine, methamphetamine, nicotine and opioids on the gut microbiome and psychiatric disorders involving anxiety, depression and psychosis. Understanding the relationship between substance use, microbiome and psychiatric disorders will provide insights for potential therapeutic targets, aimed at mitigating these adverse outcomes.
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Polanka BM, Gupta SK, So-Armah KA, Freiberg MS, Zapolski TCB, Hirsh AT, Stewart JC. Examining Depression as a Risk Factor for Cardiovascular Disease in People with HIV: A Systematic Review. Ann Behav Med 2022; 57:1-25. [PMID: 35481701 PMCID: PMC9773373 DOI: 10.1093/abm/kaab119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND People with human immunodeficiency virus (HIV) have an increased risk of cardiovascular disease (CVD) not fully accounted for by traditional or HIV-specific risk factors. Successful management of HIV does not eliminate this excess risk. Thus, there is a need to identify novel risk factors for CVD among people with HIV (PWH). PURPOSE Our objective was to systematically review the literature on one such candidate CVD risk factor in PWH-depression. METHODS A systematic literature search of PubMed, PsycINFO, EMBASE, Web of Science, and CINAHL was performed to identify published English-language studies examining associations of depression with clinical CVD, subclinical CVD, and biological mechanisms (immune activation, systemic inflammation, altered coagulation) among PWH between the earliest date and June 22, 2021. RESULTS Thirty-five articles were included. For clinical CVD (k = 8), findings suggests that depression is consistently associated with an increased risk of incident CVD. For subclinical CVD (k = 5), one longitudinal analysis reported a positive association, and four cross-sectional analyses reported null associations. For immune activation (k = 13), systemic inflammation (k = 17), and altered coagulation (k = 5), findings were mixed, and there was considerable heterogeneity in sample characteristics and methodological quality across studies. CONCLUSIONS Depression may be an independent risk factor for CVD among PWH. Additional research is needed to confirm depression's association with clinical CVD and to determine whether depression is consistently and meaningfully associated with subclinical CVD and biological mechanisms of CVD in HIV. We propose a research agenda for this emerging area.
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Affiliation(s)
| | - Samir K Gupta
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kaku A So-Armah
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Matthew S Freiberg
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Tamika C B Zapolski
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Wu Q, Zhao J, Zhao G, Li X, Du H, Chi P. Long-Term Trajectories of Depressive Symptoms Among Children Affected by Parental HIV: A 12-Year Follow-Up Study. AIDS Behav 2022; 26:2713-2722. [PMID: 35165794 DOI: 10.1007/s10461-021-03572-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 01/07/2023]
Abstract
The present study explored the trajectories of depressive symptoms over 12 years spanning from childhood to emerging adulthood and the between-trajectory differences in psychosocial adjustment among Chinese children (N = 492, 52.8% boys, aged 6 to 18 years at baseline) affected by parental HIV. Rebounding (12.6%), resilient (64.8%), and improving (22.6%) trajectories were identified. Individuals in the rebounding trajectory reported the highest levels of psychological distress and the lowest levels of subjective well-being, positive self-regard, and personal strengths in adulthood. Individuals in the resilient trajectory reported lower levels of psychological distress and negative affect than those in the improving trajectory. The findings support the development of programs by policymakers and practitioners to improve the psychosocial adjustment of children who have been affected by parental HIV while considering individual differences in the trajectories of depressive symptoms.
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dos Santos ACM, dos Santos BRC, dos Santos BB, de Moura EL, Neto ABL, Pereira e Silva AC, de Farias KF, de Medeiros Alves V, Nardi AE, de Souza Figueiredo EVM. IL-10 (-819C/T), TNFA (-30G/A) and ENOS (-786T/C) Polymorphisms Modulating the Outcome Related to Mental Disorders in Crack Addicted Users. Clin Pract Epidemiol Ment Health 2022; 18:e174501792201140. [PMID: 37274848 PMCID: PMC10156023 DOI: 10.2174/17450179-v18-e2201140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/23/2021] [Accepted: 12/20/2021] [Indexed: 06/07/2023]
Abstract
Background Cocaine/crack use affects immune system molecules and development of mental disorders has been identified. Objective To investigate the relationship of polymorphisms in the TNFA (-308G/A), IL-10 (-819C/T) and ENOS (-786T/C) genes with mental disorders in cocaine and crack users. Methods A case-control study was carried out, which included 107 cocaine and crack users and 115 controls who never used healthy cocaine and crack. The SNPs in the TNFA (-308G/A), IL-10 (-819C/T) and ENOS (-786T/C) genes were genotyped by real time PCR. Results As for the individuals included in this study, the average age of 31.4 years (± 8.59). We identified that the G/A genotype to TNFA (-308) (OR = 0.24; p = 0.03) and the A allele (OR = 0.30; p = 0.03) were associated with reduced risk for dysthymic disorder. The T allele of the IL-10 (-819) polymorphism was associated with decreased risk of developing panic disorder (OR = 0.44; p = 0.01), while the C allele was correlated with an increased risk for alcohol dependence (OR = 1.97; p = 0.04), alcohol abuse (OR = 1.81; p = 0.04) and psychotic syndrome (OR = 2.23; p = 0.01). C/C genotype was correlated with increased chances of developing current psychotic syndrome (OR = 4.23; p = 0.01). Conclusion Our results suggest that genetic polymorphisms promote susceptibility or promote protection for clinical phenotypes of psychiatric comorbidities in cocaine and crack users and be considered as good prognostic markers.
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Affiliation(s)
- Ana Caroline Melo dos Santos
- Program in Health Sciences, Molecular Biology and Gene Expression Laboratory, Federal University of Alagoas, Maceio, Brazil
| | | | - Bruna Brandão dos Santos
- Program in Health Sciences, Molecular Biology and Gene Expression Laboratory, Federal University of Alagoas, Maceio, Brazil
| | - Edilson Leite de Moura
- Program in Health Sciences, Molecular Biology and Gene Expression Laboratory, Federal University of Alagoas, Maceio, Brazil
| | - Abel Barbosa Lira Neto
- Program in Health Sciences, Molecular Biology and Gene Expression Laboratory, Federal University of Alagoas, Maceio, Brazil
| | | | - Karol Fireman de Farias
- Program in Nursing, Molecular Biology and Gene Expression Laboratory, Federal University of Alagoas, Maceio, Brazil
| | | | - Antônio Egídio Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Porto Alegre, Brazil
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Ripamonti E, Clerici M. Living With Chronic HIV Disease in the Antiretroviral Era: The Impact of Neurocognitive Impairment on Everyday Life Functions. TOPICS IN ANTIVIRAL MEDICINE 2021; 29:386-396. [PMID: 34370420 PMCID: PMC8384087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
Although there is extensive literature around the biologic correlations of neurocognitive function in HIV/AIDS, less is known about the impact in everyday living. We conducted a systematic review of the association of neurocognitive impairment with everyday life functions in people with HIV on antiretroviral therapy. We specifically focused on attention, executive function, processing speed, and the central executive component of the working memory. We considered 3 domains of everyday functions: (1) autonomy, (2) decision making and adherence to treatment, and (3) quality of life and psychologic wellbeing. The relationship between neurocognitive impairment and mental health was examined, given its correlation with everyday life functions. Results indicate that people with HIV do experience problems with autonomy of daily living (especially if aged older than 50 years) and with decision making, and neurocognitive impairment plays a role in this regard. Psychologic wellbeing is associated with executive function and processing speed. These patients may also have a reduced quality of life, but the relationship between quality of life and cognition is uncertain or could be mediated by other factors. Neurocognitive impairment correlates with depression and anxiety; however, the relationship of cognitive performance with apathy is still controversial.
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Affiliation(s)
- Enrico Ripamonti
- Send correspondence to Enrico Ripamonti, Milan Center for Neuroscience NeuroMI, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, Italy, or email
| | - Mario Clerici
- Head of the Department of Pathophysiology and Transplantation at the University of Milan in Italy
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Basil RC, Brown TT, Haberlen S, Rubin LH, Plankey M, Becker JT, Lake JE, Palella FJ, Sarkar S. The relationship between diabetes and depressive symptoms in men with or at risk of HIV infection. HIV Med 2021; 22:37-46. [PMID: 32975014 PMCID: PMC8211402 DOI: 10.1111/hiv.12958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to compare the prevalence of comorbid diabetes and depressive symptoms in men living with HIV (MLWH) with that in men without HIV infection and to determine associations between glycaemic control and depressive symptoms. METHODS Participants included 920 MLWH and 840 men without HIV infection from the Multicenter AIDS Cohort Study (MACS) with available data regarding glycaemic status [categorized as normal for fasting blood glucose (FBG) < 100 mg/dL, prediabetes for FBG 100-125 mg/dL, and diabetes, defined by self-report, diabetes medication use or FBG ≥ 126 mg/dL on at least two consecutive visits, with diabetes classified as controlled if Hemoglobin A1c (HbA1C) < 7.5% and uncontrolled if HbA1C ≥ 7.5%]. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) score, with CES-D ≥ 16 scores classified as elevated depressive symptoms. A modified Poisson regression model with robust variance was used and adjusted for covariates including HIV serostatus. RESULTS Compared to men without HIV infection, MLWH had a higher mean CES-D score, but a similar prevalence of diabetes (11.3% versus 12.8%, respectively; P = 0.33). The concomitant prevalence of diabetes and elevated depressive symptoms did not differ by HIV serostatus (P = 0.215). In an adjusted analysis, men with uncontrolled diabetes had a greater prevalence of depressive symptoms compared to men with normoglycaemia (prevalence ratio = 1.43; 95% confidence interval 1.11, 1.84). The association between glycaemic status and depressive symptoms did not differ by HIV serostatus (P = 0.22 for interaction). CONCLUSIONS Both controlled and uncontrolled diabetes were independently associated with a greater prevalence of depressive symptoms, regardless of HIV serostatus. These results highlight the importance of identifying depression in people with diabetes.
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Affiliation(s)
| | | | | | | | | | | | | | - Frank J. Palella
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Brown MJ, Serovich JM, Laschober TC, Kimberly JA. Disparities by age in depressive symptoms and substance use among men who have sex with men living with HIV. Int J STD AIDS 2020; 31:642-651. [PMID: 32448078 PMCID: PMC7299820 DOI: 10.1177/0956462420918676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of this study was to assess the association between age, depressive symptoms, and substance use among men who have sex with men (MSM) living with HIV. Baseline data were obtained from 337 MSM living with HIV. Linear and logistic regression models were used to determine the association between age and depressive symptoms and substance use. MSM aged 35-49 had higher depressive symptoms than MSM 50 and older (B = 3.53; 95% CI: 0.33, 6.72); MSM aged 25-34 and MSM 35-49 had higher substance use than MSM 50 and older (B = 2.66; 95% CI: 0.77, 4.54; and B = 1.68; 95% CI: 0.22, 3.14, respectively). MSM aged 35-49 were more likely to be at risk for clinical depression than MSM 50 and older (OR = 1.84; 95% CI: 1.06, 3.22); MSM aged 18-24 and MSM 35-49 were less likely and more likely to have substance abuse than MSM 50 and older (OR = 0.29; 95% CI: 0.09, 0.91; and OR = 1.83; 95% CI: 1.02, 3.29, respectively). Interventions addressing depressive symptoms and substance use tailored to individuals in different age groups should account for varying needs at different stages of life.
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Affiliation(s)
- Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- South Carolina SmartState Center for Healthcare Quality
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Julianne M. Serovich
- College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida
| | - Tanja C. Laschober
- College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida
| | - Judy A. Kimberly
- Division of Biology and Medicine, Brown University, Providence, Rhode Island
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Kluwe-Schiavon B, Schote AB, Vonmoos M, Hulka LM, Preller KH, Meyer J, Baumgartner MR, Grünblatt E, Quednow BB. Psychiatric symptoms and expression of glucocorticoid receptor gene in cocaine users: A longitudinal study. J Psychiatr Res 2020; 121:126-134. [PMID: 31812111 DOI: 10.1016/j.jpsychires.2019.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic cocaine users (CU) display reduced peripheral expression of the glucocorticoid receptor gene (NR3C1), which is potentially involved in stress-related psychiatric symptoms frequently occurring in CU. However, it is unknown whether psychiatric symptoms and lower NR3C1 expression are related to each other and whether reduction of drug consumption reverse them. METHOD At baseline, NR3C1 mRNA expression was measured in 68 recreational CU, 30 dependent CU, and 68 stimulant-naïve controls. Additionally, the Revised Symptom Checklist (SCL-90R) and the Barratt Impulsiveness Scale (BIS) were assessed. At a one-year follow-up, the association between change in NR3C1 expression and psychiatric symptoms was examined in 48 stimulant-naïve controls, 19 CU who increased and 19 CU who decreased their consumption. At both test sessions, cocaine concentrations in hair samples were determined. Mixed-effects models were used to investigate how changes in drug use intensity affect severity of psychiatric symptoms and NR3C1 expression over time. RESULTS At baseline, recreational and dependent CU displayed elevated impulsivity and considerable symptom burden across most of the SCL-90R subscales. Time-group interaction effects were found for several impulsivity scores, SCL-90R Global Severity Index, Paranoid Thoughts, and Depression subscales as well as for NR3C1 expression. Pairwise comparisons showed that decreasing CU specifically improved in these SCL-90R subscales, while their NR3C1 expression was adapted. Finally, changes in NR3C1 expression were negatively correlated with changes in impulsivity but not SCL-90R scores. CONCLUSION Our findings suggest that NR3C1 expression changes and some psychiatric symptoms are reversible upon reduction of cocaine intake, thus favouring abstinence-oriented treatment approaches.
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Affiliation(s)
- B Kluwe-Schiavon
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - A B Schote
- Department of Neurobehavioral Genetics, Institute of Psychobiology, University of Trier, Trier, Germany
| | - M Vonmoos
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - L M Hulka
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - K H Preller
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - J Meyer
- Department of Neurobehavioral Genetics, Institute of Psychobiology, University of Trier, Trier, Germany
| | - M R Baumgartner
- Center of Forensic Hairanalytics, Institute of Forensic Medicine, University of Zurich, Switzerland
| | - E Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - B B Quednow
- Experimental and Clinical Pharmacopsychology, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland.
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Brief Report: Reduced Use of Illicit Substances, Even Without Abstinence, Is Associated With Improved Depressive Symptoms Among People Living With HIV. J Acquir Immune Defic Syndr 2019; 79:283-287. [PMID: 30036277 DOI: 10.1097/qai.0000000000001803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Substance use is linked with poor outcomes among people living with HIV (PLWH) and is associated with mental health disorders. This analysis examines the impact of decreasing substance use, even without abstinence, on depressive symptoms among PLWH. METHODS Data are from PLWH enrolled in the Centers for AIDS Research Network of Integrated Clinical Sites cohort. Participants completed longitudinal assessments of substance use (modified ASSIST) and depressive symptoms (PHQ-9). Changes in substance use frequency were categorized as abstinence, reduced use, and nondecreasing use. Adjusted linear mixed models with time-updated change in substance use frequency and depressive symptom scores were used to examine associations between changes in the use of individual substances and depressive symptoms. Analyses were repeated using joint longitudinal survival models to examine associations with a high (PHQ-9 ≥10) score. RESULTS Among 9905 PLWH, 728 used cocaine/crack, 1016 used amphetamine-type substances (ATS), 290 used illicit opiates, and 3277 used marijuana at baseline. Changes in ATS use were associated with the greatest improvements in depressive symptoms: stopping ATS led to a mean decrease of PHQ-9 by 2.2 points (95% CI: 1.8 to 2.7) and a 61% lower odds of PHQ-9 score ≥10 (95% CI: 0.30 to 0.52), and decreasing ATS use led to a mean decrease of 1.7 points (95% CI: 1.2 to 2.3) and a 62% lower odds of PHQ-9 score ≥10 (95% CI: 0.25 to 0.56). Stopping and reducing marijuana and stopping cocaine/crack use were also associated with improvement in depressive symptoms. CONCLUSIONS We demonstrated that both substance use reduction and abstinence are associated with improvements in depressive symptoms over time.
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