A double-blind, placebo-controlled trial of desipramine for primary alcohol dependence stratified on the presence or absence of major depression.
OBJECTIVE
To assess the use of desipramine for secondary depression in primary alcohol dependence and its effect on abstinence.


METHODS
Randomized, double-blind, placebo-controlled trial, with stratification on the presence of secondary depression.


METHODS
Seventy-one volunteer and referred patients with primary alcohol dependence, abstinent a median of 8 days before randomization. A subset of 28 patients had major depression secondary to alcoholism.


METHODS
The outpatient psychiatry departments of two urban medical centers.


METHODS
Six months of a clinically determined dose of desipramine.


METHODS
Hamilton Depression Rating Scale, and Time Line Follow Back Interview, with breath alcohol concentrations and collateral verification.


RESULTS
Hamilton Depression scores of desipramine-treated depressed alcoholics decreased significantly, controlling for baseline Hamilton Depression scores (P=.04). Overall, patients were abstinent significantly longer when receiving desipramine (P=.03). Rates of relapse of depressed vs nondepressed patients, analyzed separately, were not significant, although the survival function approached significance for the depressed subgroup (P=.09). Desipramine-treated depressed patients were more satisfied and were rated as more improved.


CONCLUSIONS
Major depression secondary to alcohol dependence that is diagnosed after at least 1 week of abstinence can remain stable in some placebo-treated alcoholics and can respond to desipramine. Treating depression secondary to alcoholism may reduce risk for drinking relapse in some patients. Use of desipramine to reduce relapse in nondepressed alcoholics is not supported.
Mason
B J
BJ
Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Florida 33136, USA.
Kocsis
J H
JH
Ritvo
E C
EC
Cutler
R B
RB
D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000437:Alcoholism / Q000150:complications* / Q000188:drug therapy*; D000704:Analysis of Variance; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D003891:Desipramine / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012044:Regression Analysis; D012720:Severity of Illness Index; D016019:Survival Analysis; D013695:Temperance; D016896:Treatment Outcome
D018759:Adrenergic Uptake Inhibitors; D000929:Antidepressive Agents, Tricyclic; D003891:Desipramine