NEW YORK (Reuters Health) – Sertraline plus naltrexone is more effective than either agent alone in promoting abstinence in depressed alcohol-dependent patients, according to study findings in the March 15th online issue of the American Journal of Psychiatry.

“While some studies have demonstrated that antidepressants reduce depressive symptoms in individuals with depression and alcohol dependence, most studies have not found antidepressant treatment helpful in reducing excessive drinking in these patients,” Dr. Helen M. Pettinati, from the University of Pennsylvania, Philadelphia, and co-researchers note.

In the present study, the authors examined whether adding an agent for alcohol dependence (naltrexone) to one for depression (sertraline) could effectively address both problems.

The researchers randomized 170 depressed alcohol-dependent patients to receive 14 weeks of treatment with sertraline (200 mg/day), naltrexone (100 mg/day), both, or neither (double placebo). All subjects also received weekly cognitive-behavioral therapy.

The drug combo group had an alcohol abstinence rate of 53.7%, significantly higher than the next highest rate, 27.5%, seen with sertraline. Likewise, the median delay before relapse to heavy drinking was 98 days with combination therapy, while the next longest delay was 29 days, seen with naltrexone.

Use of the drug combo also seemed to improve depression. Roughly 83.3% of patients treated with the combo were not depressed at the end of treatment; the next highest percentage was 68.8% in the naltrexone group.

Finally, severe adverse events — most commonly anxiety/irritability and fatigue — were less common in the drug combo group than in the other groups: 11.9% vs. 26.5% with naltrexone (next highest rate).

“The co-occurrence of depression and alcohol dependence is highly prevalent and difficult to treat successfully,” the authors conclude. “The present findings suggest that patients with both disorders would benefit from combination treatment with an antidepressant and medication for alcohol dependence.”

They add, however, that current treatment guidelines should not be changed until these results are confirmed in other studies.

The study was supported in part by Pfizer Inc., which donated sertraline and matching placebo.

Reference:
Am J Psychiatry 2010.