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

Dimy Fluyau, Paroma Mitra, Ankit Jain, Vasanth Kattalai Kailasam, Christopher G. Pierre

Research output: Contribution to journalReview articlepeer-review

19 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)931-942
Number of pages12
JournalEuropean Journal of Clinical Pharmacology
Volume78
Issue number6
DOIs
StatePublished - Jun 2022

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)

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