Post-detoxification drug treatment of anxiety and depression in alcohol addicts

A study was undertaken to assess the effectiveness of treating alcoholics after detoxification for the very commonly observed syndrome of anxiety, depression, and somatic complaints. Previous studies had indicated that these patients generally respond quite well to drug treatment with the phenothiazine class of drugs. However, a double blind placebo-controlled study of adequate size had not been undertaken. Forty-five comparably addicted male alcoholics with anxiety or mixed anxiety-depression from an inpatient alcohol treatment ward comprised the treatment group. Twenty-three patients received thioridazine treatment and 22 received placebo treatment in a double blind fashion after acute withdrawal from alcohol. Progress over a 4-week period was measured with standard rating instruments--the Hamilton Rating Scale for Depression (by physician) and the Zung and Lipman Self-Rating Scales. Both placebo and active medication groups improved symptomatically during the 4-week program. The thioridazine group had significantly better improvement in sleep disturbance (early, middle, and late insomnia) than the placebo group. There was also significantly better improvement in anxiety with thioridazine as compared with placebo. Interestingly, the placebo group had significantly better work and activity (as appraised by the ward physician) than the thioridazine group. The authors note that active drug effect might actually hamper some patients in their rehabilitative effort, especially if phenothiazines of the more sedating variety are used. Since alcohol rehabilitation generally utilizes a wide range of activities (such as didactic sessions, occupation therapy, group therapy), alertness and performance ability appear to be important factors in the rehabilitation program. Although thioridazine treatment for some patients with anxiety and insomnia would appear to be quite helpful, its blanket use for the post-detoxification anxiety-depression of the alcoholic might be detrimental for others and cannot be recommended as a routine treatment strategy in an alcohol rehabilitation program.