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For alcohol dependence with depression, two meds may be better than one

March 17, 2010
by Gary A. Enos, Editor
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A newly published study finds promising outcomes from naltrexone with sertraline

The latest research to bolster the argument for combination treatments could offer hope to professionals treating co-occurring alcohol dependence and depression. A study published March 15 in the online advance edition of the American Journal of Psychiatry found that patients taking both the opioid antagonist naltrexone and the antidepressant sertraline were able to maintain abstinence from alcohol more effectively than were individuals on just one of the medications or no medication.

Another interesting facet to the study was that all study groups also received weekly cognitive-behavioral therapy (CBT) as part of study treatment; that appeared to generate reductions in depressive symptoms among study participants.

The research team led by Helen M. Pettinati, PhD, of the University of Pennsylvania, emphasized the importance of identifying and managing both disorders in patients with co-occurring problems, in that the persistence of one disorder can worsen symptoms of the other.

The study examined 170 alcohol-dependent adults with depression, randomly assigning them to 14 weeks of treatment with naltrexone alone, sertraline alone, both medications, or two placebos. The selective serotonin reuptake inhibitor (SSRI) sertraline is sold under the brand name Zoloft. The researchers selected daily doses for both medications that are in excess of federally approved standards, based on their desire to see maximum therapeutic benefits in subjects.

The researchers found that 53.7 percent of the group receiving both medications remained abstinent from alcohol use during the 14-week study period. By contrast, the combined abstinence rate in the other three treatment groups was only 23.8 percent. Also, the mean duration of time before relapse to heavy drinking was longer in the group receiving both medications (63.6 days) than in the other groups in the aggregate (42.4 days).

Study authors wrote, “There were also fewer serious adverse event reports in the medication combination group, essentially indicating that fewer patients in this group required hospitalization for alcohol detoxification or rehabilitation.”

The researchers pointed out that the study’s findings on these specific medications cannot be generalized to other medications for alcohol dependence or depression. They added that these findings need to be replicated before specific changes in current clinical practice could be recommended.

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