Antidepressants, Naltrexone, and Behavioral Therapy Help Keep Addicts Sober

Posted on March 15th, 2010

Naltrexone is an opioid receptor antagonist used primarily for treating alcohol and opioid dependence, as it helps reduce cravings for drugs and alcohol. A new study has found that combining naltrexone with the antidepressant sertraline (Zoloft) is better than either drug alone in reducing relapse for alcohol-dependent people who also suffer from depression.

Helen M. Pettinati, PhD, of the University of Pennsylvania in Philadelphia, and colleagues, reported that when given sertraline, Zoloft, and cognitive behavioral therapy, 53.7% of alcoholic and depressed patients were clean and sober for a median of 98 days, whereas 21.3% to 27.5% of those who took either drug alone of placebo were sober for less than a month.

The study, published in the American Journal of Psychiatry, enrolled 170 patients with both alcohol dependence and depression. If patients had other substance dependence issues (except for tobacco) or other mental illnesses other than depression, they were excluded from the study. Only about half of the patients who were screened were accepted into the study after taking into account these exclusions.

The patients were randomized to receive either double placebo, sertraline at 200mg/day plus placebo, naltrexone at 100 mg/day plus placebo, or both drugs at those doses for 14 weeks. All patients participated in cognitive behavioral therapy.

To measure alcohol dependence, the researchers looks at the percentage of patients who were completely abstinent during treatment and the median and mean time that heavy drinking resumed, if applicable.

Interestingly, the mean duration of abstinence in the combined-drug patients was much shorter than the median—64 days (SD 40.8) versus 98 days. For the other treatment groups, the means ranged from 40 to 45 days.

After combined treatment, 83.3% of patients were no longer clinically depressed. Fewer patients achieved clinical remission with the other treatments. Being treated with sertraline only was the least effective of the four treatments in relieving depression symptoms.

As for alcohol consumption, after 90 days, 43% of patients in the combination group were abstinent, compared with 12% to 21% of patients in the other groups. About 54% of those in the combination group did not drink heavily within the first 90 days, compared with about 30% in each of the other groups.

Ashwin Patkar, MD, of Duke University in Durham, N.C., who was not involved with the study, told MedPage Today that the study sends a good message to physicians about combining medication with behavioral therapy to treat alcohol dependence and depression. However, he warned that clinicians may not experience the same results as published in the study, as the researchers excluded patients with common co-occurring disorders that might reduce the effectiveness of treatment.
 

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