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Selective serotonin reuptake inhibitors in the treatment of depression, anxiety, and post-traumatic stress disorder in substance use disorders: a Bayesian meta-analysis

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Abstract

Purpose

Examine SSRIs’ efficacy in treating depression, anxiety, PTSD, and substance use in individuals with addiction.

Methods

From their inception until August 6, 2021, we searched Google Scholar, PubMed, Scopus, OVID MEDLINE, and Academic Search Complete. We included randomized controlled trials (RCTs) and omitted open-label studies. Bayesian analysis was performed. Bayes factor (BF) established efficacy and tau (τ) statistical heterogeneity. The RoB2 method assessed potential biases. Subgroup analysis was carried out to determine SSRI performance. Treatment duration, SSRI dosage, and attrition rate were all examined in meta-regression.

Results

We investigated 64 RCTs with 6128 participants. SSRIs reduced depressive symptoms in opioid, alcohol, cocaine, cannabis, and nicotine use disorders (d = 0.353, BF > 99); social anxiety symptoms in alcohol use disorder (d = 0.875, BF > 99); and generalized anxiety symptoms in opioid, alcohol, cocaine, marijuana, and nicotine use disorders (d = 0.346, BF = 4.236). Evidence for PTSD was inconclusive. SSRIs facilitated abstinence for opioid, alcohol, cocaine, cannabis, and nicotine use (d = 0.325, BF > 99); reduced craving for alcohol, cocaine, and nicotine use (d = 0.533, BF = 24.129); and reduced alcohol use (d = 0.452, BF > 99) and cocaine use (d = 0.255, BF = 3.87). Fluoxetine showed the highest antidepressant effect. There was no effect of attrition rate, SSRI dosage, or treatment length on SSRI's efficacy.

Conclusions

Results support the use of SSRIs to treat substance use, depression, and anxiety in individuals with addiction.

Protocol registration

PROSPERO registration number: CRD42020164944.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Dr. NE #200, Atlanta, GA, 30329, USA

    Dimy Fluyau

  2. Department of Psychiatry, NYU Langone Health, New York, NY, USA

    Paroma Mitra

  3. Pennsylvania State University, State College, PA, USA

    Ankit Jain

  4. Northern Light Health, 43 Whiting Hill Rd, Brewer, ME, 04412, USA

    Vasanth Kattalai Kailasam

  5. Grady Memorial Hospital Corp, Atlanta, GA, USA

    Christopher G. Pierre

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  1. Dimy Fluyau
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Contributions

D.F. initiated the project, developed the protocol, and searched articles in databases. D.F. and P.M. screened titles and extracted data. D.F., P.M., A.J., V.K., and C.P. reviewed the reference lists of retrieved articles for additional reports. D.F. and P.M. reviewed the full texts for selection/exclusion. D.F., P.M., A.J., V.K., and C.P. checked screening and selection. D.F. and P.M. conducted risk of bias assessment. D.F., P.M., A.J., V.K., and C.P. reviewed the outline. D.F. prepared tables and figures and drafted the methods and results sections and the introduction and discussion. D.F., P.M., A.J., and V.K. reviewed and provided intellectual contributions to the draft manuscript. D.F., P.M., A.J., V.K., and C.P. approved the final draft.

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Correspondence to Dimy Fluyau.

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Fluyau, D., Mitra, P., Jain, A. et al. Selective serotonin reuptake inhibitors in the treatment of depression, anxiety, and post-traumatic stress disorder in substance use disorders: a Bayesian meta-analysis. Eur J Clin Pharmacol 78, 931–942 (2022). https://doi.org/10.1007/s00228-022-03303-4

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