The objective of the present study was to compare the effects of the administration of mirtazapine, venlafaxine, topiramate and amisulpride as detoxification adjuncts, on anxiety and depressive symptoms and global functioning in a sample of alcohol dependent subjects

Four age-matched groups, comprising 25 subjects each, were treated with psychotherapy and adjunctive venlafaxine, mirtazapine, topiramate, or amisulpride. The Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale and the Global Assessment Scale were administered at the beginning and at the end of a 4-6 week detoxification period for the assessment of psychopathology. ANOVAs were used for comparisons between groups.

he results were: Venlafaxine: HARS=37.90±4.49, HDRS=41.52±3.47, GAS=46.00±5.07; Mirtazapine: HARS=36.02±8.41, HDRS=41.39±5.02, GAS=7.00±5.61; Topiramate: HARS=37.35±3.49, HDRS=41.00±3.16, GAS=46.50±4.00; Amisulpride: HARS=37.46±3.06, HDRS=40.82± 1.94, GAS=47.48±3.67 (ANOVA, NS). By the end of the detoxification period psychopathology significantly subsided in all four groups. However this reduction was more marked in the mirtazapine treatment group: Venlafaxine: HARS=7.44±3.36, HDRS=8.28±3.45, GAS=83,43±6,27; Mirtazapine: HARS=4.78±4.0, HDRS=3.71±3.45, GAS=86.15±7.57; Topiramate: HARS=9.55±1.25, HDRS=9.65±2.89, GAS=82.65±4.75; Amisulpride: HARS:4.72±3.44, HDRS=6.53±3.42, GAS=82.53±6.37. Thus, the mirtazapine augmentation group differed significantly from the venlafaxine group (p<.000), the topiramate group (p=.002), and the amisulpride group (p=.014).

Moderate to severe anxiety and depressive symptoms with concomitant low functioning were present in all subjects before treatment. Following 4-6 weeks of alcohol detoxification using various medications (venlafaxine, mirtazapine, topiramate, amisulpride) these symptoms subsided and reached normal levels in all study groups. However, in our study, mirtazapine appeared to be more efficient than the other medications in reducing psychopathology and improving global functioning.