Controlled comparison of tianeptine, alprazolam and mianserin in the treatment of adjustment disorders with anxiety and depression

A multicentre study compared tianeptine (37.5 mg/day), an original psychotropic compound characterized by both antidepressant and anxiolytic potentials, with a reference antidepressant, mianserin (60 mg/day) and a reference anxiolytic, alprazolam (1.5 mg/day), in the treatment of 152 patients fulfilling DSM-III-R criteria for adjustment disorder with mixed emotional features (anxiety and depression). The study used a double-blind parallel design over a 6-week period. Clinical assessments included the Clinical Global Impressions (CGI), the Montgomery and Asberg depression rating scale (MADRS), the Hamilton anxiety rating scare, a visual analogue scale, and the somatic scale of the system developed by the Association for the Methodology and Documentation in Psychiatry (AMDP). Results showed very similar improvement in the three treatment groups on all rating instruments. Moreover, the number of patients exhibiting adverse events did not differ among the three groups. Therefore, these results show similar antidepressant and anxiolytic activity for tianeptine, mianserin and alprazolam in patients suffering from adjustment disorder with mixed emotional features. These promising findings should however be confirmed in a placebo-controlled trial.