Depressive Symptoms and Alcohol Consumption among Nonalcoholic Depression Patients Treated with Desipramine

Objective: There are few data addressing the effect of alcohol consumption on response to antidepressants among nonalcoholics with depression. Similarly, the effect of antidepressant treatment on alcohol consumption in this group is not yet understood. This study focuses on changes in depressive symptoms and alcohol consumption in response to treatment with desipramine. Method: Twenty-seven nonalcoholic outpatients with major depression (as determined by the Schedule for Affective Disorders and Schizophrenia-Lifetime Version) completed measures of depression (that is, the 17-item Hamilton Depression Rating Scale and the Beck Depression Inventory) and alcohol consumption at intake and after 5 weeks of open treatment with desipramine. Subjects were characterized as minimal or mild-to-moderate drinkers. Results: There was no significant difference between the groups with respect to effectiveness of antidepressant treatment. Analysis for repeated measures demonstrated that alcohol consumption with desipramine was significantly lower after treatment than at intake (F = 4.8, df 23:2, P Conclusions: Desipramine treatment appeared to result in decreases in alcohol consumption in nonalcoholic patients with depression. Further research is needed to elucidate the effect of alcohol consumption on the course and outcome of major depressive illness among nonalcoholics as well as the effect of antidepressant medication on alcohol consumption in this population. (Can J Psychiatry 2004;49:859-862) Information on author affiliations appears at the end of the article. Clinical Implications * Desipramine may attenuate alcohol consumption among nonalcoholics with depression. * Previous studies have suggested that nonalcoholic patients with depression would benefit by minimizing their consumption of alcohol. * Changes in alcohol and carbohydrate consumption during antidepressant treatment may be independent of changes in depressive symptoms. Limitations * The study sample was relatively small. * The length of this trial may not have been sufficient to detect the effect of alcohol on response to desipramine. * Alcohol consumption was determined by self-report and may be an underestimate of actual alcohol consumption. Key Words: depression, alcohol consumption, desipramine, carbohydrate consumption The cooccurrence of alcohol use disorders has been reported to adversely affect the course, treatment, and prognosis of major depressive disorder (1,2). What is less clearly understood is the significance of mild-to-moderate alcohol consumption on treatment response among patients with major depression. To our knowledge, Worthington and colleagues reported the only findings regarding nonabusive alcohol consumption in depression patients treated with fluoxetine (3). They found that the level of alcohol consumption at baseline predicted significantly poorer response to treatment and a nonsignificant trend toward lowered alcohol consumption in the treatment group. There are, however, no previous studies of tricyclic antidepressants (TCAs) in this respect. This study prospectively examines the effect of pretreatment alcohol consumption on response to treatment with desipramine, as well as the effect of desipramine treatment on alcohol consumption in nonalcoholic subjects with depression. We hypothesized that subjects who abstained or drank minimally would show greater depressive symptom reduction than would those with moderate alcohol consumption. Method The study sample comprised 27 consecutive outpatients (21 women and 6 men) referred to the Depression Clinic at the Clarke site of the Centre for Addiction and Mental Health, University of Toronto. At baseline, after they provided written informed consent, all patients were administered the Schedule for Affective Disorders and Schizophrenia Lifetime Version (SADS-LV, 4), the 17-item Hamilton Depression Rating Scale (HDRS, 5), the Beck Depression Inventory (BDI, 6), and the Food Pattern Questionnaire (FPQ, 7). …