Thursday, March 25, 2010

Depression Alcohol Dependence Combination Therapy

There was an interesting study in the March issue of the American Journal of Psychiatry that looked at combining medication treatment for those alcohol dependent patients who also suffered from co-occurring major depression. This study is important for one conclusion but as I have noted before with various studies the researchers often come to other conclusions that are not necessarily supported by their own evidence.

170 depressed alcohol dependent patients (mean 43.4 years of age) were randomly assigned to 14 weeks of the antidepressant sertraline (Zoloft) at 200 mg/day (the maximum dose), to the alcohol dependence drug naltrexone(Revia), to both drugs, or to double placebo groups and studied for a period of 14 weeks. All patients received weekly cognitive-behavioral therapy. The important finding was that at the end of 14 weeks 53% in the sertraline-naltrexone group maintained abstinence compared with an average of 23.8% for the other three treatments. This is very striking and may have significant implications for how we treat depressed alcoholics. Limitations of the study are the relatively small number of participants and the time frame of the study (3 1/2 months). But this is an important finding and one in which I hope there will be more follow-up for a longer period of time, enroll more patients, and separate out differences between men and women as well as those who received inpatient treatment compared with those were did not.

The other point they try to make in this study is that those receiving both treatments were less depressed than those with sertraline alone. They try to make the the point that there was a trend in that direction but the trend did not reach statistical significance. Reporting and highlighting trends that are not statistically significant is often a problem in that these results get reported in the media as important findings as well as the main findings and people come to conclusions that are not really supported by the evidence.

So in this case the improved abstinence rates at 3 1/2 months for the combined group is extremely important but we cannot say at this time that the combined treatment actually helps the depression.

Thought for the day

53% abstinence in a population with a co -occurring and serious psychiatric disorder is encouraging.

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