P-537 - Comparative analysis of dual serotonergic and noradrenergic antidepressants in double depression with alcohol dependence

Abstract

Objective: To evaluate the comparative medium-term efficacy of dual antidepressants in patients with dysthymic disorder and major depressive disorder who also met criteria for alcohol dependence. Methods: A group of 16 patients, mean age 43.2, diagnosed with dysthymic disorder and major depressive disorder, according to DSM IV TR criteria, were screened positive for alcohol dependence during the initial interview. Antidepressants used were dual agents-venlafaxine mean daily dose 225 mg (n=7), milnacipran 100 mg (n=5) and duloxetine 75.6 mg (n=4). Other drugs were used in the treatment of alcohol related pathology, like naltrexone 50 mg/day and anxiolytics. Patients were monitored every 4 weeks for 6 months using Hamilton Depression Rating Scale (HAMD)-17 items, Clinical Global Impressions-Severity/Improvement (CGI-S/I), Global Assessment of Functioning (GAF), Inventory of Drug Taking Situations-alcohol focused version (IDTS). Results: Depressive symptoms responded well to all three antidepressants, with a slow trend in favor of venlafaxine (HAMD score-15.6 vs.-13.3 duloxetine and-12.2 milnacipran), but without statistical significance (p=0.122). CGI-I showed also a significant improvement at endpoint (3.2 mean decrease, p< 0.01) for all three antidepressants. GAF increased accordingly, to a mean value of 82.3 at week 24, compared to baseline. The severity of alcohol dependence fluctuated, but mean values of IDTS at endpoint improved with 56.5% for venlafaxine, 52.2% for milnacipran and 50.1% for duloxetine. A number of 4 patients relapsed into alcohol abuse during the trial. Conclusion: Serotonergic and dopaminergic reuptake inhibitors are useful in the treatment of double depression associated with alcohol dependence.