The use of antidepressants in alcohol-dependent veterans.
BACKGROUND
Although some research reports suggest antidepressants may be an effective treatment for alcohol dependence, their clinical use has been controversial.


METHODS
By using comprehensive national administrative data from the Department of Veterans Affairs (VA) documenting psychiatric diagnoses and care under natural conditions in both mental health and non-mental health settings, the use of antidepressants was compared in alcoholic and non-alcoholic veterans. Data were collected from April 1, 2000, to Sept. 30, 2000.


RESULTS
Overall, patients with alcohol dependence were significantly more likely to be prescribed antidepressants than individuals without alcoholism (38.9% vs. 31.2%), but multivariate analysis showed that this was attributable to the higher rate of comorbid psychiatric diagnoses in this group. After controlling for diagnosis and other potentially confounding factors, alcohol-dependent individuals treated in specialty mental health clinics were in fact less likely to be prescribed antidepressants (odds ratio = 0.95, p <.0001). Of patients treated with antidepressants, those with alcohol dependence were more likely to be prescribed newer antidepressants (odds ratio = 1.22, p <.0001). Among patients treated in non-mental health clinics, there were no significant differences in rate of antidepressant use between alcohol-dependent and non-alcohol-dependent individuals with mental illness after controlling for other factors.


CONCLUSIONS
The principal finding is that a diagnosis of alcoholism, independent of other factors, is associated with a decreased likelihood of receiving antidepressant treatment in VA mental health clinics, suggesting that prescribers have not embraced reports of their efficacy in alcohol dependence. In fact, this may reflect a disinclination to use medications to treat alcoholism in specialty mental health clinics but not in non-mental health clinics.
Petrakis
Ismene L
IL
Department of Psychiatry, Yale University, New Haven, Conn., USA. ismene.petrakis@yale.edu
Leslie
Douglas
D
Rosenheck
Robert
R
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000188:drug therapy* / Q000453:epidemiology; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015897:Comorbidity; D004363:Drug Utilization; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*
D000928:Antidepressive Agents