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. 2023 May;32(3):291-300.
doi: 10.1111/ajad.13371. Epub 2023 Jan 16.

Trajectories of depression among patients in treatment for opioid use disorder: A growth mixture model secondary analysis of the XBOT trial

Noel Vest  1 , Kevin Wenzel  2 , Tse-Hwei Choo  3 , Martina Pavlicova  3 , John Rotrosen  4 , Edward Nunes  3 , Joshua D Lee  4 , Marc Fishman  2   5
Affiliations

Trajectories of depression among patients in treatment for opioid use disorder: A growth mixture model secondary analysis of the XBOT trial

Noel Vest et al. Am J Addict. 2023 May.

Abstract

Background and objectives: To inform clinical practice, we identified subgroups of adults based on levels of depression symptomatology over time during opioid use disorder (OUD) treatment.

Methods: Participants were 474 adults in a 24-week treatment trial for OUD. Depression symptoms were measured using the 17-item Hamilton Depression Rating Scale (HAM-D) at nine-time points. This was a secondary analysis of the Clinical Trials Network Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment (XBOT) trial using a growth mixture model.

Results: Three distinct depression trajectories were identified: Class 1 High Recurring-10% with high HAM-D with initial partial reductions (of HAM-D across time), Class 2 Persistently High-5% with persistently high HAM-D, and Class 3 Low Declining-85% of the participants, with low HAM-D with early sustained reductions. The majority (low declining) had levels of depression that improved in the first 4 weeks and then stabilized across the treatment period. In contrast, 15% (high recurring and persistently high) had high initial levels that were more variable across time. The persistently high class had higher rates of opioid relapse.

Discussion and conclusions: In this OUD sample, most depressive symptomatology was mild and improved after medication treatment for opioid use disorder (MOUD). Smaller subgroups had higher depressive symptoms that persisted or recurred after the initiation of MOUD. Depressive symptoms should be followed in patients initiating treatment for OUD, and when persistent, should prompt further evaluation and consideration of antidepressant treatment.

Scientific significance: This study is the first to identify three distinct depression trajectories among a large clinical sample of individuals in MOUD treatment.

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Conflict of interest statement

Declaration of Interest:

Marc Fishman has been a consultant for Alkermes, the manufacturer of XR-NTX. The authors alone are responsible for the content and writing of this paper.

Figures

Figure 1.
Figure 1.
Mean levels of depression (HAM-D) by class across the 24-week treatment period. Note: Class 1 – Improved then Recurring (n=45, 10%), Class 2 – Persistently High (n=25, 5%), and Class 3 – Low Declining (n=404, 85%).
Figure 2.
Figure 2.
Relapse free survival by class. Note: Significant difference in time-to-relapse between GMM classes (p=0.0007)
See this image and copyright information in PMC

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