TIANEPTINE AND ALCOHOL DEPENDENCE

Several arguments are in favour of the use of antidepressant drugs in alcohol-dependent patients, especially those acting on the serotoniner gic system: (1) neurochemical data indicate the interaction between al cohol and 5-HT metabolism, (2) pharmacological studies show an improve ment in the behaviour of alcoholized animals treated with antidepressa nts, (3) depression is a frequent disease in alcoholic patients. Tiane ptine has been shown to be active in the treatment of depression in pa tients with history of alcohol abuse or dependence. In a first double- blind study performed versus amitryptiline, depression after withdrawa l was improved by tianeptine, and biological abnormalities usually rel ated to chronic alcohol intake tended to decrease. Similar results wer e found in an open study carried out on 277 alcoholic patients treated for 1 year. As these patients were depressed, no definite conclusion could be drawn from these results in respect of a specific action of t ianeptine on alcohol dependence. Thus, a multicentre double-blind stud y has been performed which compared tianeptine (12.5 mg t.i.d) and pla cebo in 342 non-depressed patients fulfilling DSM-III-R criteria for P sychoactive Substance Dependence (alcohol). Other inclusion criteria w ere: daily alcohol intake higher than 80 g, minimum score of 3 on the Short-Mast Questionnaire, mean corpuscular volume above 98 fl and/or g amma Gt more than twice the upper limit of normal. The patients were t reated for 9 months, The intention-to-treat population and the per pro tocol population were made up of 327 patients and 111 patients, respec tively. The main efficacy criterion was the absence of alcoholic relap se (abstinence) defined by the patient's statements, the investigators clinical judgement and some biological parameters: alcohol blood leve ls, gamma Gt levels. Secondary criteria were the evolution of the alco hol consumption in the patients who relapsed, cumulative abstinence du ration, a visual analogue scale for the evaluation of the appetence fo r alcohol and the clinical global impressions scale. The statistical a nalysis showed no difference between both groups in respect of the mai ntenance of abstinence (intention-to-treat and per protocol population s). In spite of the methodological problems of the studies in dependen ce (choice of the inclusion and efficacy criteria, especially), the pr eliminary results obtained with the serotoninergic antidepressants wer e not confirmed in the different trials performed in the maintenance o f alcohol abstinence. The indication of tianeptine should be restricte d to the treatment of depressive syndromes, which have a high lifetime prevalence in the alcoholic patient, and which have a noticeable role on the alcoholic relapse. (C) 1997 Elsevier Science B.V.