Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
5.8 Major clinical issues with depression and inhalant/ solvent use
- Depression and inhalant use often co-exist and both increase suicide risk.
- Inhalants can exacerbate the sedative effects of some antidepressants.
- Most antidepressants reduce seizure threshold and tricyclic antidepressants can cause cardiac arrhythmias - both complications of inhalant use.
- As with most other substances, inhalant users should be encouraged to try and reduce or cease use to observe whether depressive symptomatology resolves.
5.8.1 Effects of inhalants/ solvents on depression
- Depression and use of inhalants are positively correlated, particularly amongst adolescents(63, 64).
- Depression and inhalant use, and inhalant use alone are associated with increased risk of suicide(64, 197-200).
5.8.2 Interactions between inhalants/ solvents and therapeutic agents for depression
- Inhalants can exacerbate the sedative effects of some antidepressants including tricyclic antidepressants and mirtazepinex.
- Most antidepressants reduce seizure threshold and tricyclic antidepressants can cause cardiac arrhythmias. Therefore, risks should be appraised prior to commencementx.
5.8.3 Management approaches to comorbid depression and inhalant/ solvent use
- There appears to be no literature that sheds light on managing people with both depression and inhalant/solvent use related problems.
- As with most other substances, inhalant users should be encouraged to reduce or cease use to observe whether depressive symptomatology resolves.
- In general, with respect to inhalant/solvent use(65):
- Outline to users the harms associated with inhalant/solvent use.
- Investigate polysubstance use as this is common.
- Standard CBT approaches to both sets of issues should be used, with particular attention to the development of:
- Assertiveness skills (refusal skills).
- Coping skills for controlling and managing emotions such as anger and sadness.
- Offer alternatives to inhalant use, for example, recreational activities.
- Community reinforcement approaches should be developed by mobilising the local health and welfare service system in individual care plans.
- Family interventions need to be considered, for example, increasing communication between the person and the family.
- Assertive outreach and follow-up may be required.