Our major goal is to evaluate the hypothesis that the subgroup of alcoholics who have depressive disorder should be matched with a treatment regimen which includes antidepressant medication in addition to a psychosocial intervention. Clinical experience and diagnostic studies suggest that a small but significant proportion of alcoholics have a concomitant depressive disorder. This subset of alcoholics may be """"""""self-medicating"""""""" their depression, and appropriate pharmacologic treatment of the depressive disorder should promote resolution of the alcoholism as well. A series of placebo-controlled trials have shown little long-term effect of tricyclic antidepressants on alcoholism. However, these trials suffer from inadequate methodology, most notably a failure to select samples of alcoholics with potentially antidepressant responsive syndromes. We propose to test the incremental effectiveness of a tricyclic antidepressant, imipramine, in addition to alcoholism counseling in a sample of alcohol dependent patients selected for the presence of DSM III depressive disorder based on lifetime psychiatric history. We propose a 10 month, three phase program of treatment and research with a naturalistic follow-up evaluation at month 10. Phase I is a 12 week open label trail of imipramine. Responders are defined as patients who both sober and experience resolution of their depressive symptoms. Responders enter Phase II, which is a 6 week maintenance phase. Patients who maintain their response (target N=80 patients) enter Phase III, which is a 6 month, double- blind placebo controlled discontinuation trial, where half remain on imipramine while half switch to placebo. Counseling continues in both groups. We hypothesize a higher rate of relapse to both depressive disorder and alcoholism in the placebo group than in the imipramine group. We also propose to retrospectively examine our baseline measures of psychiatric, alcohol and psychosocial variables to develop a scale of predictors of favorable response to imipramine.
| McGrath, P J; Nunes, E V; Quitkin, F M (2000) Current concepts in the treatment of depression in alcohol-dependent patients. Psychiatr Clin North Am 23:695-711, V |
| Nunes, E V; Quitkin, F M (1997) Treatment of depression in drug-dependent patients: effects on mood and drug use. NIDA Res Monogr 172:61-85 |
| Nunes, E V; Deliyannides, D; Donovan, S et al. (1996) The management of treatment resistance in depressed patients with substance use disorders. Psychiatr Clin North Am 19:311-27 |
| Nunes, E V; McGrath, P J; Quitkin, F M (1995) Treating anxiety in patients with alcoholism. J Clin Psychiatry 56 Suppl 2:3-9 |
| Nunes, E V; McGrath, P J; Quitkin, F M et al. (1993) Imipramine treatment of alcoholism with comorbid depression. Am J Psychiatry 150:963-5 |
