A Comparison of the Safety and Efficacy of Alprazolam and Desipramine in Moderately Severe Depression

Abstract

Fifty-four patients (34 outpatients, 20 inpatients) fulfilling Research Diagnostic Criteria for Definite Major Depressive Disorder were enrolled in a double-blind study comparing the antidepressant effects of alprazolam versus desipramine. The mean daily dose of alprazolam and desipramine at study termination was 3.78 mg and 208 mg respectively. As there were no significant demographic or clinical differences between outpatients and inpatients, both groups were combined in data analysis. Using the Hamilton Depression Rating Scale (HAM-D) both drug groups showed highly significant improvement beginning with the first week of active drug treatment. HAM-D scores continued to decrease through study termination (six weeks of active drug). There were no significant differences when comparing alprazolam and desipramine (outpatients, inpatients, or both groups combined) on any of the subjective or objective psychometrics used in this study. Clinically, only twelve of thirty-four outpatients (35.3%) were felt to be "markedly or moderately" improved, suggesting that neither the outpatient alprazolam nor desipramine patients did particularly well with drug treatment. In terms of drug safety there was no difference between the alprazolam and desipramine in the number of excessive or serious drug side effects. However, five of twenty-nine alprazolam patients had to discontinue therapy because of excessive drowsiness, and two of the alprazolam outpatients had motor vehicle accidents directly related to this adverse event. Alprazolam appeared as effective as desipramine in the pharmacotherapy of this group of depressed outpatient and inpatients. Alprazolam appeared well-tolerated by most subjects although drowsiness was a common--and at times serious--medication side effect.

Benzodiazepines as a Monotherapy in Depressive Disorders: A Systematic Review

“…Regarding response to treatment, 9 of these studies found an overall improvement, with no significant differences across medication classes [41-43, 45, 46, 49, 51, 52, 54], even in the setting of melancholia [54], in both outpatients and inpatients [49]. Results significantly favoring the use of TCA were found in 4 studies [44,47,48,50].…”

“…Participants were assigned at random to the conditions in all studies, and all were double-blind trials. ITT analyses were performed in 8 reports [19,20,23,28,30,31,42,53], completers' data only were reported in 12 studies [25,27,29,37,39,41,44,45,47,49,50,54], and handling of attrition was not reported in 2 studies [46,48].…”

“…Fourteen reports compared BZD and TCA in the treatment of depression [41,42], major depressive disorder [43][44][45][46][47], and serious forms of endogenous depression [48][49][50][51][52][53] including 1 with melancholic characteristics [54] (online suppl. Table 1).…”

Anxiolytics’ Effects on the Actual Driving Performance of Patients and Healthy Volunteers in a Standardized Test

“…It has also become apparent that seda tion during benzodiazepine use is responsible for increas ing outpatients' risk of injury and death in motor vehicle accidents. An early warning came from one clinical trial when 2 of 16 outpatients receiving alprazolam in a 3.5-mg average daily dose became involved in accidents before completing their scheduled 6-week treatment periods [2]. The latest evidence has come from a retrospective, casecontrol epidemiological survey.…”