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 i n primary alcohol dependence and its effect on abstinence. Design.-Ran domized, double-blind, placebo-controlled trial, with stratification o n the presence of secondary depression. Subjects.-Seventy-one voluntee r and referred patients with primary alcohol dependence, abstinent a m edian of 8 days before randomization. A subset of 28 patients had majo r depression secondary to alcoholism. Setting.-The outpatient psychiat ry departments of two urban medical centers. Intervention.-Six months of a clinically determined dose of desipramine. Main Outcome Measures. -Hamilton Depression Rating Scale, and Time Line Follow Back Interview , with breath alcohol concentrations and collateral verification. Resu lts.-Hamilton Depression scores of desipramine-treated depressed alcoh olics decreased significantly, controlling for baseline Hamilton Depre ssion scores (P=.04). Overall, patients were abstinent significantly l onger when receiving desipramine (P=.03). Rates of relapse of depresse d vs nondepressed patients, analyzed separately, were not significant, although the survival function approached significance for the depres sed Subgroup (P=.09). Desipramine-treated depressed patients were more satisfied and were rated as more improved. Conclusions.-Major depress ion secondary to alcohol dependence that is diagnosed after at least 1 week of abstinence can remain stable in some placebo-treated alcoholi cs and can respond to desipramine. Treating depression secondary to al coholism may reduce risk for drinking relapse in some patients. Use of desipramine to reduce relapse in nondepressed alcoholics is not suppo rted.