| ObjectiveWe conducted a systematic review and meta-analysis of the effectiveness of antidepressants for this co-occurring disorder in adolescents and young adults.Methods.A Meta-analysis of randomized controlled clinical trials.Participants A comprehensive literature search of PubMed,Cochrane,Embase,Web of Science and Psych INFO were conducted(from 1970 to2013).Prospective,parallel groups,double-blind,controlled trials with random assignment to an antidepressants or placebo on young patients(age?25 years)who met diagnostic criteria of both substance use and unipolar depressive disorder were included.Five trials were selected for this analysis and included 290 patients.Our efficacy outcome measure was the depression outcomes(dichotomous and continuous measures)and the substance-use outcomes(change of frequency or quantity of substance-use).Secondary analysis was conducted to access the tolerability of antidepressants treatment.Results.For dichotomous depression outcome,antidepressants group was significantly more effective than placebo group(RR=1.21;95%CI 1.01 to1.45)with low heterogeneity(I~2=0%).Although no statistically significant effects for continuous depression outcome(SMD=-0.13;95%CI,-0.55 to0.30)was found with moderate heterogeneity(I~2=63%),subgroup analysis showed medicine group with sample size of more than 50 showed a statistically significant efficacy compared with the placebo group(SMD-0.53,95%CI-0.82 to-0.25).Moreover,there was no significant difference for substance-use outcomes and tolerability outcomes between medication group and placebo group.Conclusions.Antidepressant medication shows a modest beneficial efficacy in young patients with combined depressive and substance use disorders,while there is no evidence that antidepressant treatment improves substance use outcome from these data,thus emphasis needs to be placed on additional treatment of the addiction. |
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