Antidepressants are commonly used in substance abusers due to the potential effect on some underlying mechanisms involved in
drug use disorders and to treat comorbid depression. A systematic review of the literature of the efficacy of
antidepressant drugs in subjects with
drug abuse disorders, including alcohol,
cocaine,
nicotine and
opioid, with and without comorbid depression was performed. Only randomised, double-blind, controlled trials have been evaluated. A meta-analysis was done with the included studies that used common evaluation procedures in alcohol,
cocaine and
opioid dependence. Based on the present review some recommendations may be proposed. The prescription of
antidepressants for
drug abuse seems only clear for
nicotine dependence with or without previous comorbid depression (
bupropion and nortryptiline). In
alcohol dependence without comorbid depression, the use of any
antidepressant seems not justified, while in
cocaine dependence has to be clarified. The use of
antidepressants in alcohol,
cocaine or
opioid dependence with comorbid depression needs more studies in well-defined samples, adequate doses and
duration of treatment to be really conclusive. Interestingly,
SSRIs do not seem to offer significant advantages compared with tricyclic drugs in
substance abuse disorders. Differences both related to individual characteristics and specific
antidepressant drugs need to be clarified in future studies.