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To the Editor: In the clinical trial by Dr Johnson and colleagues,¹ topiramate reduced the percentage of heavy drinking days in selected alcohol-dependent individuals. However, there was an important exclusion criterion that was not addressed in the discussion.

The study methods note that participants were excluded who "had a current Axis I psychiatric diagnosis on the DSM-IV other than alcohol, nicotine, or caffeine dependence," so that patients with current Axis I mood or anxiety disorders were not included in this trial. This may represent a large percentage of persons with alcohol dependence. In a community-based national survey of 43 093 respondents representative of a noninstitutionalized population (the National Epidemiologic Survey on Alcohol and Related Conditions), the 12-month prevalence of any mood disorder among persons with alcohol dependence was 28%, and the prevalence of any anxiety disorder was 23%.² Among those with any alcohol use disorder who sought treatment in the past . . . [Full Text of this Article]

Olivier Ameisen, MD
oameisen@hotmail.com
Paris, France