Patients with both systemic lupus erythematous (SLE) and major depressive disorder (MDD) are more likely to also have an issue with several substances including alcohol, tobacco, opioids, and cannabis.

A team, led by Xiaofeng Yan, MD, PhD, investigated whether comorbid MDD in patients with SLE is associated with an increased prevalence of substance use disorder (SUD) diagnoses and whether SUD is higher among patients with SLE.

SLE and MDD

Recent research has shown patients with SLE have a higher prevalence of MDD. In fact, SLE is considered an independent risk factor for MDD confirmed by population-based evidence. There is also a strong link between substance use disorders and MDD and patients with SLE are more likely to drink more alcohol.

In the study, presented during the 2023 American Psychiatric Association (APA) annual meeting in San Francisco, investigators extracted data from I2B2, a de-identified dataset from the electronic medical record (EMR) of a university-affiliated hospital, both from inpatient and outpatient settings.

The investigators used ICD10 codes of different diagnose to guide the search.

The Patients

Overall, they identified 743 patients with SLE and 37,623 patients with MDD. In this group, there were 317 patients with SLE that had comorbid MDD.

The majority of patients were aged between 50-60 years (26%) and were female (88%).

The results show 42.66% of the patient population with SLE also had MDD, but only 132 were treated with antidepressants (41.64%).

Patients in the comorbid MDD group were more likely to have a diagnoses of tobacco, alcohol, opioid, cannabis, stimulants, hallucinogens, sedatives-hypnotics, or anxiolytic use disorders compared to patients with only SLE.

Tobacco (59.94%) was the most common SUD, while sedative, hypotonic, and anxiolytic use disorder were the least common (59.94%).

“This study demonstrates a consistently higher rate of SUD diagnoses among patients diagnosed with SLE and comorbid MDD versus SLE alone,” the authors wrote. “For clinicians who take care of patients with SLE, when they have comorbid MDD, substance use disorders should be screened to improve clinical care and outcomes.”

A new symptom checklist could help enable primary care physicians to better diagnose and assess the severity of patients with SUD.

Cannabis Use

A team, led by Thomas E. Matson, PhD, MPH, Kaiser Permanente Washington Health Research Institute, evaluated the psychometric properties of the Substance Use Symptom Checklist used in primary care among patients who report daily cannabis use and/or other drug use.

SUDs are commonly underrecognized in primary care settings, largely because structured clinical interviews can be infeasible. However, 1 potential option is a brief, standardized substance use symptom checklist to help assess SUD.

The study involved 23,304 individuals screened with a mean age of 38.2 years. Of this group, 16,140 patients reported daily cannabis use only, 4791 patients reported other drug use only, and 2373 patients reported both daily cannabis and other drug use.

The results show 26.3% (n = 4242) of patients in the daily cannabis use only group endorsed 2 or more items on the symptom checklist, consistent with DSM-5 SUD, compared to 30.2% (n = 1446) of the other drug use group and 51.8% (n = 1229) of the daily cannabis and other drug use group.