Medication combinations are proving more beneficial in alcohol use disorder

Colin MacKenzie M.D.

December 5, 2020

Combining a selective serotonin reuptake inhibitor and naltrexone demonstrates greater benefits in alcohol use disorder. 

Introduction

The combination of depression and alcohol dependence is a common co-occurring condition. Under such conditions, it is vital to diagnose and treat both disorders because one problem can aggravate the other. Only limited studies are available that support the benefits of using medicines to treat both conditions simultaneously. A study by Helen M.Pettinati and colleagues published in the American Journal of Psychiatry has evaluated the benefits of simultaneously administering two FDA-approved drugs, sertraline for depression and naltrexone for alcohol dependence.

Design

In the study, 170 patients with a dual diagnosis of depression and alcohol dependence participated. They were randomly divided into four groups of nearly similar size. The first group was treated with both sertraline and naltrexone. The second group was treated with naltrexone and a placebo, the third with Sertraline and a placebo, and the fourth with two placebos. All the groups were treated for 14 weeks. Weekly cognitive behavioral therapy was continued. 

Results

At the end of the therapy, the first group that received treatment with both drugs achieved significantly positive outcomes compared to the other groups. The summary of the results are as follows: 

• The proportion of members who abstained from alcohol in the first group (sertraline plus naltrexone) was more than two times that of the other groups.
• The average number of days after which the participants in the first group relapsed to heavy drinking was 56 days compared to 32 days for the other three groups.
• The first group experienced fewer adverse events including anxiety/irritability, headache, nausea, fatigue, sexual issues, hospitalization for detoxification, or rehabilitation. They also exhibited fewer depressive symptoms.

Conclusion

This study concludes that the simultaneous administration of medicines, specifically sertraline and naltrexone, to treat co-occurring alcohol dependence and depression could lead to prolonged abstinence, delayed relapse, fewer adverse events, and less depressive symptoms.

Pettinati, H.M., Oslin, D.W., Kampman, K.M., Dundon, W.D., Xie, H., Gallis, T.L., Dackis, C.A. and O'Brien, C.P., 2010. A double-blind, placebo-controlled trial combining sertraline and naltrexone for treating co-occurring depression and alcohol dependence. American Journal of Psychiatry, 167(6), pp.668-675.

https://doi.org/10.1176/appi.ajp.2009.08060852