Exploring the Depressive Syndrome of Heroin Use Disorder patients. Relationships between Worthlessness/Being Trapped, Deficit Reward and Post-Withdrawal Syndromes

Background. The Worthlessness/Being Trapped (W/BT) is a stable depressive psychopathological dimension and part of the psychopathology specific to Heroin Use Disorder (HUD) found by us in fulfilling our ten-year research plan. Methods. Selecting patients from the Pisa-Database we compared W/BT items in 504 depressed patients without a history of substance use (NSU-MD), 125 depressed HUD patients (W/BT-HUD) and 847 non-depressed ones (HUD). We analysed differences in the frequency and severity of W/BT items, at the multivariate level (multinomial logistic regression and discriminant analysis). Results: W/BT-HUD patients differed from HUD ones in having a higher frequency of the female gender and in displaying the following syndrome: 'feeling blue', 'worried about sloppiness or carelessness', 'feeling lonely', 'feeling everything is an effort', 'never feeling close to another person'. Conversely, 'worrying too much about things' was more frequent in non-depressed HUD patients. W/BT-HUD subjects differed from MD ones without substance use ones in showing more symptoms characterized by 'worried about sloppiness or carelessness', 'your feelings being easily hurt', 'feeling lonely even when you are with people', 'feelings of guilt', 'your mind going blank', 'trouble concentrating', 'unwanted thoughts, words, or ideas that won't leave your mind', 'feeling blocked in getting things done'. By contrast, NSU-MD patients were made recognisable by the following characteristics: 'feeling lonely', 'feeling of worthlessness', 'feeling tense of keyed up', 'worrying too much about things', 'loss of sexual interest or pleasure', 'blaming yourself for things', and 'feelings of being trapped or caught'. MD and W/BT-HUD patients were differentiated by the higher severity in them of the traits: 'worrying about sloppiness or carelessness', 'feeling lonely', 'difficulty in making decisions', and 'feelings of guilt'. W/BT-HUD patients feel less trapped, more dysphoric, and less sexually disinterested than depressed, drug-free patients. Conclusions: The depressive syndrome found in W/BT-HUD patients can differentiate W/BT-HUD patients from drug-free, depressed ones, so further adding weight to the hypothesis of its specificity to HUD. The lack of the usual depressive symptoms in W/BT-HUD patients can lead to an incorrect estimation of depression in HUD patients when those symptoms are not reported