Course of late-life depression with alcoholism following combination therapy.
OBJECTIVE
The comorbidity of alcoholism and depression increases the complexity of treatment and is associated with severe disability and morbidity. However, long-term treatment algorithms have been understudied.


METHODS
This study examined the natural course of 74 depressed alcoholics over 6 to 12 months following a 12-week acute-phase trial of sertraline (Zoloft), naltrexone (Revia), and compliance enhancement therapy. Subjects were monitored for long-term outcomes based on their acute-phase trial response.


RESULTS
Fifty-four subjects followed up at 6 months, and 50 subjects remained at the 12-month visit. Full responders at the end of the 12-week acute-phase trial sustained better overall outcomes (6 months: chi2=19.9, 4 df, p=.001; 12 months: chi2=11.7, 4 df, p=.020) and better drinking and depression outcomes, as compared with partial responders and nonresponders over a 6-month and 12-month period.


CONCLUSIONS
Initial full responders sustain better overall treatment outcomes at 6 and 12 months, compared with partial responders and nonresponders. The defined outcome categories incorporate meaningful and practical measures of severity and can help predict treatment outcomes in clinical practice, thereby allowing timely interventions. Future studies should focus on maintenance strategies for full responders and treatment adaptations for partial responders and nonresponders.
Gopalakrishnan
Raman
R
Penn Presbyterian Medical Center, University of Pennsylvania Health System, Behavioral Health/Wright-5, 39th Street and Market Street, Philadelphia, Pennsylvania 19104, USA. raman133@gmail.com
Ross
Jennifer
J
O'Brien
Charles
C
Oslin
David
D
D000375:Aging; D000437:Alcoholism / Q000150:complications* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003863:Depression / Q000150:complications* / Q000628:therapy*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage* / Q000627:therapeutic use; D010919:Placebos; D020280:Sertraline / Q000008:administration & dosage* / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
D010919:Placebos; D009271:Naltrexone; D020280:Sertraline