Tuesday, April 8, 2014

New Medication Shows Promise for Effective Treatment of Alcoholism and Depression



Meg Brunner, MLIS
Librarian
Alcohol & Drug Abuse Institute, University of Washington
CTN Dissemination Library

Alcoholism is often accompanied by co-occurring mental health disorders such as depression. While evidence-based medications for alcoholism treatment are effective in reducing cravings and preventing relapse, a single medication to treat alcoholism and co-occurring depression has not been available.   

A long-term study partially funded by NIDA’s National Drug Abuse Treatment Clinical Trials Network (CTN) found promising results for the treatment of alcoholism with co-occurring depression using the antidepressant mirtazapine (trade name Remeron).

Mirtazapine is unique among antidepressants, unrelated to tricyclics or selective serotonin reuptake inhibitors (SSRIs).  Instead, it is classified as a second-generation “tetracyclic” antidepressant and is commonly used both for treatment of depression and also as an appetite stimulant and antiemetic.

Recently, it has also demonstrated effectiveness as a medication used to treat substance abuse disorders.

Though this particular study was very small, conducted with only 12 adult outpatient subjects suffering from both alcoholism and major depressive disorder, the results were impressive, with self-reported depressive symptoms decreasing by 74% and drinking decreasing by 60.8% at the end of the study’s 8-week acute phase.  

Additionally, while none of the subjects in the study were employed full-time at baseline, by the 2-month mark, 75% of them were back to full-time work, suggesting an increase in level of functioning thanks to decreases in both depressive symptoms and alcohol use.

All of these clinical improvements occurred relatively quickly after starting mirtazapine, as well, which is consistent with the rapid onset of response in previous research about this medication.

Two years after entry into the acute phase of this study, 10 of the 12 original patients were evaluated for long-term effects.  The large magnitude improvements in depressive symptoms, drinking, and sleep disturbances persisted.  Only 2 of the patients demonstrated symptoms of major depressive disorder at the 2-year follow-up, while all 10 had at baseline.  Six of the 10 had continued to use antidepressants during the follow-up period.

These preliminary findings suggest exciting possibilities for the use of mirtazapine as a treatment for co-occurring depression and alcoholism in both acute and long-term treatment phases. It is hoped that this study will encourage further research on this medication’s efficacy, as double-blind studies are needed to confirm these results. 

Citations:
Cornelius JR, Douaihy AB, Clark DB, et al. Mirtazapine in comorbid major depression and alcohol dependence: an open-label trial. J Dual Diagnosis 2012;8(3):200-204.

Cornelius JR, Douaihy AB, Clark DB, et al. Mirtazapine in comorbid major depression and alcohol use disorder: a long-term follow-up study. J Addict Behav 2013;2:4.



Meg Brunner, MLIS, has been a research librarian and web development specialist at the University of Washington’s Alcohol & Drug Abuse Institute in Seattle since 1996. Along with Nancy Sutherland, MLS, she runs the National Drug Abuse Treatment Clinical Trials Network (CTN) Dissemination Library, an online library of materials by and about the NIDA CTN.  Meg Brunner is also very active in the international organization Substance Abuse Librarians & Information Specialists (SALIS), where she has served as Chair of the Executive Board and is currently the editor of their quarterly newsletter, SALIS News.  She is also a new member of the Addiction Technology Transfer Center (ATTC) Network’s Advisory Board.  In her personal time, she writes for her humorous web site and book/movie review blog at http://megwood.com, featured in Elle Canada, Mademoiselle, USA Today, and Yahoo! Magazine, and serves on the Board of Directors at Purrfect Pals, a regional cat shelter and sanctuary.

9 comments:

  1. SORRY, but with an N=12 to state that a substance shows promise is very unscientific, actually it is ridiculous if not outright misleading.

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  2. I'm sorry you found the post misleading, but it was noted clearly that this was a small-scale study and that more research, especially double-blind studies, are needed to confirm the results. For people suffering from alcoholism and depression, these results, however small, are quite promising! This is often how research on new treatments begins -- with very small test studies aimed at determining whether research on a larger scale is warranted. These results demonstrate that those larger scale studies are definitely worth doing!

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  3. This is an exciting study. I would be willing to try it today with my patients combined with therapy. Certainly it has been difficult to treat this co-occuring disorder so worth a try. Thanks.

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  4. It is early but I hope there will be an exploratory study after these indications.

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  9. Once I started on SSRIS I went from social drinking to alcoholic, I then came off SSRIS and went onto Mirtazapine and my intense cravings disappeared very quickly. Mirtazapine does work, I told my story on http://davidhealy.org/out-of-my-mind-driven-to-drink/. There are hundreds of other people reporting the same intense cravings for alcohol on SSRIS on many forums.

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