Korean Journal of Biological Psychiatry

Objective : It has been proposed that cognition and related aspects of mental functioning are decreased in depression as well as in alcoholism. The objective of the study was to compare behavioral side effects of paroxetine and amitriptyline in depressed patients accompanied by alcoholism. The focused comparisons were durg effects concerning psychomotor performance, cognitive function, sleep and daytime sleepiness during the first 2 weeks of treatment.

Methods : After an alcohol detoxification period(3 weeks) and a washout period(1 week), a total of 20 male inpatients with alcohol use disorder(DSM-IV), who also had a major depressive episode(DSM-IV), were treatment double-blind with paroxetine 20mg/day(n=10) or amitriptyline 25mg/day(n=10) for 2 weeks. All patients were required to have a score of at least 18 respectively on both the Hamilton Rating Scale for Depression(HAM-D) and Beck Depression Inventory(BD) at predrug baseline. Patients randomized to paroxetine received active medication in the morning and placebo in the evening whereas those randomized to amitriptyline received active medication in the evening and placebo in the morning. Al patients performed the various tasks in a test battery at baseline and at days 3, 7 and 14. The test battery included : critical flicker fusion threshold for sensory information processing capacity ; choice reaction time for gross psychomotor performance ; tracking accuracy and latency of response to peripheral stimulus as a measure of fine sensorimotor co-ordination and divided attention : digit symbol substitution as a measure of sustained attention and concentration. To rate perceived sleep and daytime sleepiness, 10cm line visual analogue scales were employed at baseline and at days 3, 7 and 14. The subjective rating scales were adapted for this study from Leeds Sleep Evaluation Questionnaire and Epworth Sleepiness Scale. In Addition a comprehensive side effect assessment, using the UKU side effect rating scale, was carried out at baseline and at days 7 and 14. The efficacy of treatment was evaluated using HAM-D, BDI and clinical global impression for severity and improvement at days 7 and 14. 

Results : The pattern of results indicated that paroxetine improved performance on most of the test variables and also improved sleep with no effect on daytime sleepiness over the study period. In contrast, amitriptyline produced disruption of performance on some tests and improved sleep with increased daytime sleepiness in particular at day 3. On the UKU side effect rating scale, more side effects ere registered on amitriptyline. The therapeutic efficacy was observed in favor of paroxetine early in day 7.

Conclusion : These results demonstrated that paroxetine in much better than amitriptyline for the treatment of depressed patients accompained by alcoholism at least in terms of behavioral safety and tolerability. Furthermore the results may assist in explaining the therapeutic outcome of paroxetine for example, and earlier onset of antidepressant action of paroxetine may be caused by early improved cognitive function or by contributing to good compliance with treatment.

Keywords Paroxetine;Amitriptyline;Depression;Alcoholism;Behavioral side effects.