On Monday 12th of January Wendela ter Meulen will defend her PhD thesis titled ‘Comorbidity of mood disorders and substance use disorders: in concert and co-travelling,’ in the Auditorium of the Vrije Universiteit Amsterdam at 11:45.
Wendela ter Meulen is a researcher in the department of Psychiatry, Amsterdam UMC and psychiatrist at the psychiatric Intensive Care Unit of GGZ inGeest.
She investigated why mood disorders frequently play in concert with substance use disorders and why also tend to co-travel over time. In the first part of this study, Wendela and colleagues summarised studies on the most common psychiatric comorbidity, namely depression and anxiety. They found that people with this comorbidity experienced a higher psychiatric burden and were more likely to have a wide range of physical, mental, and social problems. Risk factors—factors that may contribute to comorbidity—were primarily psychosocial in nature, such as childhood trauma.
In the second part of the study, they focused on the comorbidity of mood disorders and substance use problems. First, comparing risk factors for smoking, such as low income, between people with and without depression. Wendela found that people with depression smoked by far the most and were also most exposed to problematic factors that can facilitate smoking behaviour. Then, she focused on so-called disease progression, meaning that some people with a mood disorder recover less well from depression over time—over the course of years—or experience more episodes of bipolar mood problems. Findings show that this disease progression promoted the ‘co-travelling’ of comorbid mood disorders and substance use problems. In addition, results show that a particular clinical measurement instrument, which also assesses comorbidity, was able to somewhat predict the transition from depression to bipolar disorder.
Findings
Wendela summarises: “My research underscores that comorbidity is associated with an accumulation of various adverse factors and poorer psychiatric outcomes. This argues in favour of treating this group of patients in an integrated manner rather than separately.” Less well known is the finding that this co-travelling over time is driven primarily by progression of the mood disorder. Wendela’s research suggests that especially early in the course of bipolar disorder, caution with substance use is warranted, as there may be a ‘window of vulnerability’ during which these substances have a particularly destabilising effect. Furthermore, it appears that smokers who are also depressed need to recover at least partially from their depression—perhaps not even completely—before smoking behaviour can decrease. Treatment of persistent depression is generally a challenge, and this research advocates a joint approach, such as psychotherapy, that simultaneously addresses both depression and substance use problems.
Wendela ter Meulen works as a psychiatrist and researcher. She is fascinated by the co-occurrence of mood disorders and substance use disorders. Intrigued that this concert often seemed considerably unfortunate in terms of psychiatric and functional outcomes, Wendela started thinking of a research project. Two questions emerged: why do mood disorders frequently play in concert with substance use disorders and why do they co-travel over time? Her curiosity was generously rewarded with the opportunity to pour these questions into a PhD trajectory.
On Monday 12th of January Wendela ter Meulen will defend her PhD thesis titled ‘Comorbidity of mood disorders and substance use disorders: in concert and co-travelling,’ in the Auditorium of the Vrije Universiteit Amsterdam at 11:45. Wendela’s thesis is supervised by prof. em. Ralph Kupka, prof. em. Aartjan Beekman and co-supervised by dr. Stasja Draisma. More information on this dissertation can be found on the website of VU Amsterdam.
