Mianserin in the treatment of depressive symptoms in alcoholics. a double-blind placebo controlled study using a computer delivered self-rating scale
McLean, P.C.; Ancill, R.J.; Szulecka, T.K.
Psychiatria Polska 20(6): 417-427
1986
ISSN/ISBN: 0033-2674 PMID: 3299432 Document Number: 4346
This study does not aim to elucidate the nature of depression in alcoholics, which remains obscure, the evidence being conflicting and equivocal, a reflection, perhaps of the distorting and unpredictable effects of alcohol itself on mood. It seems fairly certain that few alcoholics suffer from primary affective disorder, but that many have depressive states which may be due to toxic effects, withdrawal effects or to the unpleasant situations which alcohol abuse often precipitates. Depressed alcoholics are more similar to non-depressed alcoholics than they are to non-alcoholic depressives. The random assignment of the depressed patients to either the mianserin or placebo groups created two groups of patients similar as regards age and sex distribution and not differing significantly in the degree of depressive symptomatology found at entry into the trial. After four weeks there was no significant difference in the depression scores between the mianserin group and the placebo group. We must conclude therefore that the depressive symptoms of alcoholic patients do not remit as a consequence of the administration of mianserin, even though this drug is accepted as an effective antidepressant agent. This finding is in accord with many other studies which have failed to show a beneficial effect of other antidepressant or mood altering substances on the depressive symptoms of withdrawing alcoholics. It is posible that our negative results might have been due to the fairly low (60 mg daily) dosage of mianserin used. A higher dose might have produced a more pronounced effect. Some authors have pointed out the need for adequate dosage and monitoring of plasma antidepressant concentrations, emphasising the frequent metabolic changes in alcoholics which may lead to decreased effectiveness of antidepressants because of alcohol-induced enzyme changes. Few adverse effects were noted - transient drowsiness being the only unwanted effect in the mianserin group. The lack of side effects, the safety in overdosage and the known effectivenes of mianserin seem to indicate that mianserin might be useful as an antidepressant in those alcoholics with primary depressive illness although it can interact with alcohol. It is perhaps of note that although mianserin has been thought to induce occasional convulsions in susceptible individuals, this did not happen in our study which involved treating patients who are considered to be particularly at risk of having convulsions. In fact, the only convulsion occurred in a patient in the placebo group. Our study indicates that it is the detoxifying process, whether it be the anxiolytics or other drugs used, the vitamins, the absence of alcohol, the removal to a safe unstressed environment or the therapeutic activities of the treatment unit, which resolves depressive symptoms and not the antidepressant drug. We therefore suggest that it is inadvisable to prescribe antidepressant drugs routinely to all alcoholics who complain of depression. A novel aspect of this study is the use of a microcomputer to administer the self-rating scale used. We have already commented upon the acceptability of the computer to the patients and it obviously provides a completely standardised way of collecting information. It also never forgets, does not miss out items and only accepts sensible answers. There is a further advantage. Patients are often unwilling to divulge information which may show then in a bad light. Of particular interest when assessing depression is the finding that patients were much more likely to admit to suicidal ideation to the computer than they were to the doctor. The use of computers to obtain information, either for research or clinical purposes, would appear to be especially appropriate in the fields of depression and alcoholism.
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