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Table 2 Therapeutic strategies depending on comorbid substance use disorders

From: Clinical guidelines for the management of depression with specific comorbid psychiatric conditions French recommendations from experts (the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental)

Comorbidity First intention Second intention Contra-indications
Severe substance use disorders (except alcohol and nicotine) - SSRI
- SNRI
- α2 antagonist
- Concurrent treatment of MDD and addiction
- Disease management involving a team specialised in addictology, psychoeducational groups or a psychotherapy focusing on addictive relapse prevention
- Imipraminic
- Agomelatine
- Tianeptine
- Irreversible non selective MAOI
- First-generation antipsychotic
- Association of ATD
- Anticonvulsant
Severe comorbid alcohol addiction - SSRI
- SNRI
- α2 antagonist
- Structured Psychotherapy
  - Disulfiram
- Tianeptine
- Bupropion
- Irreversible non selective MAOI
- Treatment of MDD alone
Active smoking - SSRI
- SNRI
- α2 antagonist
- Structured Psychotherapy
- Concurrent treatment of MDD and smoking-cessation
- Imipraminic
- Agomelatine
- Irreversible non selective MAOI
- Tianeptine
  1. AAP Atypical antipsychotic, ATD Antidepressant, MAOI monoamine oxidase inhibitor, MDD Major depressive disorder, SSRI Selective serotonin reuptake inhibitors, SNRI Dual serotonin and norepinephrine reuptake inhibitors