A DOUBLE-BLIND, PLACEBO-CONTROLLED PILOT-STUDY OF CARBAMAZEPINE FOR THE TREATMENT OF ALCOHOL DEPENDENCE

Carbamazepine, chemically related to the tricyclic antidepressants, ha s multiple clinical actions. It is a potent anticonvulsant, mild sedat ive, and mood stabilizer. It is nonaddictive and has little toxicity w hen clinical and laboratory monitoring is performed, It has proven eff icacy in the treatment of acute alcohol withdrawal. Kindling and protr acted withdrawal are the theoretical rationale for the mechanism of it s action in the treatment of alcohol dependence. This 12-month double- blind placebo-controlled pilot study of 29 subjects evaluated the effi cacy of carbamazepine for the treatment of alcohol dependence. Subject s were randomly assigned to either placebo or carbamazepine. A baselin e assessment and bimonthly follow-up for 12 months assessed demographi c variables, mood and functioning, treatment compliance, drinking beha viors, biological markers of drinking, and medication toxicity. Despit e the small sample size, compliance difficulties after 4 months and a sizable drop-out rate, there were treatment effects favoring carbamaze pine. Univariate analyses showed a decrease in drinks per drinking day and maximum number of heavy drinking days in a row at 2 and 4 months of follow-up. Survival analysis revealed a significant delay in time t o first episode of heavy drinking, and close to a trend lever of signi ficance for time to first drink. There were significant time, but not time by treatment group, effects on multiple measures of mood. These p ilot results are encouraging and support carbamazepine as a possible p harmacologic tool in the treatment of alcohol dependence.