Alcohol-use disorders and depression: results from individual patient data meta-analysis of the acamprosate-controlled studies.
OBJECTIVE
To examine the predictors and correlates of depression in alcoholic patients following detoxification and during outpatient treatment, and the role of acamprosate.


METHODS
The international research program of acamprosate has involved 6500 patients in randomized, placebo-controlled trials. Extensive baseline and follow-up data were documented for each patient. An individual patient data meta-analysis was conducted on a partial database.


RESULTS
From 3354 patients in 11 studies (10 countries), we found 1120 (33.4% confidence intervals: 31.8-35.0) depressed patients (DPs). Among alcohol patients, the profile of DPs can be defined by five predictors: being female, younger, unemployed and living alone and being an episodic drinker. Compared with non-depressed patients (NDPs), their motivation to start a treatment and the compliance to treatment were lower. DPs performed less than NDPs in achieving abstinence. The acamprosate effect in increasing abstinence was similar for both DPs and NDPs patients. Abstinence during the trial was the key factor of depression remission: DPs were 7.58 times more likely to become NDPs if they were continuously abstinent.


CONCLUSIONS
Our results justify the need to systematically identify depression among alcohol-dependent patients, but to treat the alcohol dependence as a first step, because enhancing abstinence will often involve remission of the depressive disorder.
Department of Psychiatry, Hospital Bichat-Claude Bernard, AP-HP Paris, 75877 Paris Cedex 18, France. michel.lejoyeux@bch.aphp.fr
Michel
M
Lejoyeux
Philippe
P
Lehert
D000077443:Acamprosate; D000427:Alcohol Deterrents / Q000009:adverse effects / Q000627:therapeutic use*; D019973:Alcohol-Related Disorders / Q000188:drug therapy* / Q000628:therapy; D000437:Alcoholism / Q000150:complications* / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D010349:Patient Compliance; D011569:Psychiatric Status Rating Scales; D013375:Substance Withdrawal Syndrome / Q000150:complications / Q000188:drug therapy; D013654:Taurine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013695:Temperance; D016896:Treatment Outcome; D005723:gamma-Glutamyltransferase / Q000097:blood
D000427:Alcohol Deterrents; D013654:Taurine; D005723:gamma-Glutamyltransferase; D000077443:Acamprosate