title: The effect of mianserin add-on, on the intensity of opioid withdrawal symptoms during detoxification program--a randomized, double blind, placebo controlled, prospective study.
abstract: BACKGROUND
  Based on pre-clinical studies regarding the interaction of various antidepressant drugs with the opioid system, we designed a clinical study to be carried out in the 'in-patient detoxification unit' within a large community centre for treatment of drugs dependent people. We evaluated the effect of mianserin add-on, on the intensity of opioid withdrawal symptoms in opiate dependent subjects undergoing medication-supported physical detoxification and integrated psychosocial and psychotherapeutic intervention for the treatment of dependence.
  
  
  METHODS
  Mianserin (or placebo) was added to the routine medication protocol, during the 3-week in-patient phase of detoxification in a prospective, randomized, double blind, placebo controlled study. Mianserin (or placebo) was continued after discharge and patients were followed up for 3 months in order to evaluate relapse rates. Opiate withdrawal symptoms were assessed during the first 10 days, while depression and anxiety were assessed throughout the 3 months of study.
  
  
  RESULTS
  From day 2 onward, patients in the study group showed significantly lower withdrawal symptoms than the control group patients and reached this peak faster (study group 2.8 days, control group 3.2 days, p<0.001). However, drop out rates were higher in the study group throughout the study period and only 13% of the study group patients, compared to 30% of the control group patients reached the end point.
  
  
  CONCLUSIONS
  Though adding mianserin to the medication treatment during detoxification of opiate-dependent persons attenuated significantly both the intensity and the duration of withdrawal symptoms, the overall drop out rate was negatively influenced in the study group compared to the control group and fewer patients completed the study. Further study is needed in order to establish the origin of the paradox of higher drop out rates in the presence of attenuated intensity and duration of opiate withdrawal symptoms in the study group, and the clinical implications that should be drown.
authors.affiliation: Jaffa Centre for the Treatment of Drug Victims and Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Herman
authors.forename: D
authors.initials: D
authors.lastname: Shamir
authors.forename: R
authors.initials: R
authors.lastname: Bar-Hamburger
authors.forename: C G
authors.initials: CG
authors.lastname: Pick
authors.forename: S
authors.initials: S
authors.lastname: Schreiber
mesh_terms: D000704:Analysis of Variance; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001007:Anxiety / Q000209:etiology; D003866:Depressive Disorder / Q000209:etiology; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008803:Mianserin / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010349:Patient Compliance; D011446:Prospective Studies; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D016019:Survival Analysis
chemical_list: D018687:Antidepressive Agents, Second-Generation; D008803:Mianserin