Table 2 Therapeutic strategies depending on comorbid substance use disorders
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 |