FLUOXETINE ATTENUATES ALCOHOL INTAKE AND DESIRE TO DRINK

Several serotonin uptake inhibitors, including the long-acting fluoxet ine, have been found to decrease alcohol intake in moderately dependen t alcoholics. While the mechanism of their effect is not fully elucida ted, a previous study with citalopram indicated that decreased desire to drink may be an important factor. Therefore, we tested fluoxetine e ffects on alcohol intake and desire to drink in a placebo-controlled s tudy. Subjects, recruited by advertisement, were mildly/moderately dep endent alcoholics (12 male, four female, aged 19-59 years, healthy, no n-depressed) who did not believe they had a drinking problem and were not requesting treatment. After a 1 week baseline they received, singl e-blind, 2 weeks placebo followed by 2 weeks fluoxetine 60 mg/day. As out-patients, subjects recorded daily standard drinks (13.6 g ethanol) and rated interest, desire, craving and liking for alcohol biweekly. Each out-patient period was immediately followed by a double-blind exp erimental drinking session. Out-patient daily drinks slightly decrease d during fluoxetine to 6.6 +/- 0.9 (X) over bar +/- S.E.M.) compared w ith during placebo (7.16 +/- 0.95,p = 0.07, N.S.) and baseline (7.18 /- 1.0,p > 0.1, N.S.). Desire, interest and craving for alcohol decrea sed during fluoxetine vs placebo baseline (p < 0.05), but not vs place bo. Appetite loss and decrease in food intake (p < 0.01, fluoxetine vs placebo) correlated with each other (r = 0.91,p < 0.01) but neither c orrelated with decrease in alcohol intake (appetite: 0.26, N.S.; food intake: r = 0.22, N.S.). Weight loss occurred during fluoxetine (p < 0 .05 vs placebo) but did not correlate with decrease in alcohol intake (r = 0.1, N.S.). In the experimental drinking sessions after placebo a nd fluoxetine treatments subjects rated their desire for each of 18 mi ni-drinks (each one-third of a standard drink) offered at 5 min interv als. Fluoxetine decreased desire to drink throughout the sessions; bot h mean and maximum desire ratings were lower after fluoxetine than aft er placebo (ANOVA, p < 0.05). Therefore, fluoxetine seems to have a ro bust effect on decreasing desire for alcohol. We propose that in the a bsence of intention by subjects to reduce drinking, their habitual dri nking patterns mitigated against reduced consumption in the out-patien t phase. However, fluoxetine could be a useful adjunct for patients in a treatment context who are motivated to reduce their drinking.