Many opioid users exhibit symptoms of anxiety and depression at the time of presentation for treatment.

  • Most but not all studies link psychiatric distress to poorer treatment outcome.

  • Multiple studies have indicated that MMT can reduce levels of psychiatric distress with improvement apparent within weeks of commencement of treatment.

    • After stabilisation on methadone, screen all patients again for psychiatric disorders. A careful and detailed mental state examination will usually suffice.

  • Psychotherapy as an adjunct to MMT may benefit patients with medium and high levels of psychiatric problems, but for those with low severity psychiatric problems the addition of psychotherapy offers no advantage.

  • Depression has been found to predict poor psycho-social functioning and to increase the risk of relapse to heroin use in the event of life crises.

  • Evidence of the effectiveness of antidepressants as adjuncts to MMT is equivocal with only a few studies demonstrating favourable effects on mood.

  • One Australian cohort study found antidepressant use was associated with higher levels of polydrug use, poorer health and higher levels of psychiatric distress, and a greater risk of heroin overdose. The excess risk of overdose was specifically associated with tricyclic antidepressants.