Effectiveness of tianeptine in patients with major depressive disorder and substance use disorder.

espanolIntroduccion. La depresion coexiste frecuentemente con los trastornos por uso de sustancias (TUS), lo que conlleva un peor pronostico. Existe una importante falta de evidencia sobre las intervenciones terapeuticas mas efectivas para esta comorbilidad. Los estudios existentes sugieren que los antidepresivos disponibles actualmente son poco eficaces para estos pacientes. La disponibilidad terapeutica de antidepresivos con mecanismos neurobiologicos diferentes podria ser una alternativa. El objetivo es describir la evolucion de un grupo de pacientes con esta comorbilidad que han realizado tratamiento con tianeptina en condiciones de practica clinica habitual en consultas de deshabituacion. Metodologia. Se diseno un estudio postautorizacion, multicentrico, retrospectivo y observacional de practica clinica habitual. Se revisaron las historias clinicas de los 100 ultimos pacientes diagnosticados de depresion mayor y TUS, tratados con tianeptina durante al menos 3 meses. Se evaluaron en tres ocasiones (inicial, intermedia y final a los 3 meses) las siguientes escalas: Escala de Evaluacion para la Depresion de Hamilton (HDRS), Escala de Impresion Clinica Global (ICG) y Escala de Gravedad de la Adiccion (SDS). Resultados. La mayoria de los pacientes fueron tratados con una combinacion de psicofarmacos y psicoterapia. Al final del seguimiento 70 pacientes (70 %) obtuvieron una remision clinica segun la escala HDRS y 76 pacientes (76 %) se clasificaron con mucha o moderada mejoria segun ICG. Respecto al consumo, los descensos mas destacados se produjeron en los trastornos por uso de alcohol y cocaina. Conclusion. Tianeptina, en monoterapia o en combinacion, puede ser un tratamiento de utilidad para pacientes con depresion dual de forma conjunta con otras medidas terapeuticas que traten de forma integrada estos pacientes complejos. EnglishIntroduction. The depressive disorder coexists in a high prevalence with a substance-related disorder, which is associated with a worst prognosis. The therapeutic interventions for this co-morbidity lack of the appropriate scientific support. The existing evidence suggest that the currently available anti-depressive drugs are of minor efficacy in this group of patients. An alternative would be the use of different drugs with distinctive neurobiological mechanism of action. The aim of this study was to describe the clinical development of a series of patients affected by this comorbidity under treatment with tianeptine under usual clinical practices. Methods. Study design corresponds to a post-authorization, observational, retrospective, multicentric, study under usual clinical practice study. The clinical history of the last consecutive 100 patients diagnosed of major depressive and substance-related disorders under treatment with tianeptine for at least 3 months was reviewed. The following scales were evaluated in 3 times (basal, intermediate, final): HDRS, ICG and SDS.Results. Most patients were treated by a combination of anti-depressive drugs together with psychotherapy. At the end of follow-up, 70 % patients had a clinical remission in accordance with HDRS and 76 % of them had a mild or significant improvement in ICG. Regarding the use of substances, the most remarkable decreases were obtained in the consumption of alcohol, and cocaine. Conclusion. Tianeptine could be a useful drug for the treatment of patients with dual diagnosis of depression and substance-related disorder, together with other therapeutic interventions.