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Co-occurrence of depression and a substance use disorder (SUD) in patients who present dual diagnoses has been long recognized as an important consideration in clinical practice. This review synthesizes the evidence of pharmacological and psychosocial interventions for comorbid depressive disorders and SUDs while providing clinical recommendations about the best interventions to address these patients. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Our results suggest that 1) In patients with depression and alcohol consumption, the administration of non-selective serotonin reuptake inhibitor (SSRI) antidepressants instead of SSRI is recommended for improvement of depressive symptoms (strong recommendation). Neither SSRI (strong recommendation) nor non-SSRI (weak recommendation) antidepressants are recommended for reduction in alcohol consumption. 2) In patients with depression and cannabis use, the use of venlafaxine is not recommended (weak recommendation). 3) In patients with depression and cocaine consumption, the use of SSRI antidepressants for improving depressive symptoms (weak recommendation) or to reduce cocaine use is not recommended (strong recommendation). The use of non-SSRI antidepressants is only recommended for improving depressive symptoms (strong recommendation). 4) The administration of bupropion to reduce nicotine consumption is not recommended (strong recommendation). 5) Regarding psychological treatment, in patients with depression and co-occurring alcohol disorder, both pharmacotherapy and cognitive behavioural therapy have positive effects on internalizing symptoms and in reducing alcohol consumption (weak recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite evidence.

Se aprecia en los últimos años un incremento de borracheras en los jóvenes que salen a divertirse. Se dispone de menos información sobre la relación entre la sexualidad y la embriaguez en estos contextos. Se analiza en una muestra de 440 jóvenes de 14 a 25 años habituales de contextos recreativos nocturnos, que han tenido relaciones sexuales y consumen algún tipo de droga o alcohol, las razones para no mantener relaciones sexuales en función del consumo abusivo de alcohol (borracheras) y del género. Para el muestreo se utilizó la técnica respondent-driven sampling. Los resultados indican que un 63.3% reconoce que bajo los efectos del alcohol u otras drogas no han tomado medidas de control en sus relaciones sexuales, siendo más las mujeres que no toman medidas. Los resultados referidos a los motivos para no mantener relaciones sexuales son semejantes por género y grado de embriaguez. Solo aparece la diferencia de que las mujeres las rechazan más cuando consideran que la pareja no es apropiada. Un análisis de regresión logística indica que las borracheras es la variable más importante para explicar las distintas conductas sexuales. Se concluye que las borracheras inciden en no tomar medidas de control en la relaciones sexuales, siendo semejantes los resultados en hombres y en mujeres Recent years have seen an increase in drunkenness among young people who go out at weekends, but there is limited information on the relationship between sexuality and drunkenness in these contexts. Here we analyze, in a sample of 440 people aged 14 to 25 who frequent nightlife recreational contexts, who have had sexual relationships and who use some type of drug or alcohol, the reasons for not initiating a sexual liason, as a function of drunkenness and gender. The sampling method used was respondent-driven sampling. The results show that 63.3% admit that under the effects of alcohol or other drugs they have failed to take precautions in their sexual relations, the proportion of women not taking precautions being higher than that of men. The results referring to the reasons for not initiating a sexual liason are similar across genders and states of drunkenness. The only difference found is that women are more likely to reject sex when the prospective partner is inappropriate. A logistic regression analysis indicates that drunkenness is the most important variable in explaining the different sexual behaviors. We conclude that drunkenness is related to the failure to take precautions in sexual relations, the results being similar in men and women Este estudio se ha realizado en parte con financiación de la Delegación del Gobierno para el Plan Nacional sobre Drogas según la Orden de convocatoria SCO/269/2007, y con la financiación del Health and Consumer Protection Directorate General (European Commission; grant agreement 2004319) SI