A double-blind, placebo-controlled study of sertraline with naltrexone for alcohol dependence.
BACKGROUND
Significant preclinical evidence exists for a synergistic interaction between the opioid and the serotonin systems in determining alcohol consumption. Naltrexone, an opiate receptor antagonist, is approved for the treatment of alcohol dependence. This double-blind placebo-controlled study examined whether the efficacy of naltrexone would be augmented by concurrent treatment with sertraline, a selective serotonin receptor uptake inhibitor (SSRI).


METHODS
One hundred and thirteen participants meeting DSM IV alcohol dependence criteria, who were abstinent from alcohol between 5 and 30 days, were randomly assigned to receive one of two treatments at two sites. One group received naltrexone 12.5 mg once daily for 3 days, 25 mg once daily for 4 days, and 50 mg once daily for the next 11 weeks, together with placebo sertraline. The other group received naltrexone as outlined and simultaneously received sertraline 50 mg once daily for 2 weeks, followed by 100 mg once daily for 10 weeks. Both groups received group relapse prevention psychotherapy on a weekly basis.


RESULTS
Compliance and attendance rates were comparable and high. The groups did not differ on the two primary outcomes, time to first drink and time to relapse to heavy drinking, or on secondary treatment outcomes. With the exception of sexual side effects which were more common in the combination group, most adverse events were similar for the two conditions.


CONCLUSIONS
As the doses are tested in combination with specialized behavioral therapy, this study does not provide sufficient evidence for the combined use of sertraline and naltrexone above naltrexone alone.
Farren
Conor K
CK
Yale University School of Medicine, Department of Psychiatry, Substance Abuse Treatment Unit, 1 Long Wharf, New Haven, CT 06419, United States. cfarren@stpatsmail.com
Scimeca
Michael
M
Wu
Ran
R
Malley
Stephanie O
SO
D000328:Adult; D017668:Age of Onset; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D010349:Patient Compliance; D018579:Patient Selection; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D020280:Sertraline / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D009271:Naltrexone; D009292:Narcotic Antagonists; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline