Mirtazapine in comorbid major depression and alcohol dependence: An open-label trial.

This CTN platform study is a pilot study evaluating the acute phase (8-week) efficacy of the antidepressant medication mirtazapine for the treatment of depressive symptoms and drinking of subjects with comorbid major depressive disorder and alcohol dependence (MDD/AD). The authors hypothesized that mirtazapine would demonstrate within-group efficacy for the treatment of both depressive symptoms and drinking in these subjects. The study was conducted with 12 adult outpatient subjects with comorbid MDD/AD at the Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center, a community treatment provider in the National Drug Abuse Treatment Clinical Trials Network (CTN). The pharmacological profile of mirtazapine is unique among antidepressants, unrelated to tricyclics or selective serotonin reuptake inhibitors. Results indicated that mirtazapine was well-tolerated in this treatment population. Self-reported depressive symptoms decreased from 31.8 to 8.3 on the Beck Depression Inventory (BDI), a 74% decrease, and drinking decreased from 33.9 to 13.3 drinks per week, a 60.8% decrease. None of the subjects were employed full-time at baseline, but 9 of the 12 (75%) were employed full-time by the end of the study.

Conclusions: These preliminary findings suggest efficacy for mirtazapine for treating both the depressive symptoms and excessive alcohol use of comorbid major depressive disorder and alcohol dependence. The increase in number of employed subjects noted during this treatment trial suggests an increase in level of functioning associated with the decreases in depressive symptoms and level of drinking. These clinical improvements occurred relatively quickly after starting mirtazapine, as well, which is consistent with the rapid onset of response noted by previous authors. Double-blind studies are warranted to further clarify the efficacy of mirtazapine in this population.