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 in primary alcohol dependence and its effect on abstinence.

Design.  —Randomized, double-blind, placebo-controlled trial, with stratification on the presence of secondary depression.

Subjects.  —Seventy-one volunteer and referred patients with primary alcohol dependence, abstinent a median of 8 days before randomization. A subset of 28 patients had major depression secondary to alcoholism.

Setting.  —The outpatient psychiatry 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.

Results.  —Hamilton Depression scores of desipramine-treated depressed alcoholics decreased significantly, controlling for baseline Hamilton Depression scores (P=.04). Overall, patients were abstinent significantly longer when receiving desipramine (P=.03). Rates of relapse of depressed vs nondepressed patients, analyzed separately, were not significant, although the survival function approached significance for the depressed subgroup (P=.09). Desipramine-treated depressed patients were more satisfied and were rated as more improved.

Conclusions.  —Major depression secondary to alcohol dependence that is diagnosed after at least 1 week of abstinence can remain stable in some placebotreated alcoholics and can respond to desipramine. Treating depression secondary to alcoholism may reduce risk for drinking relapse in some patients. Use of desipramine to reduce relapse in nondepressed alcoholics is not supported.(JAMA. 1996;275:761-767)