Double-blind clinical trial of sertraline treatment for alcohol dependence

Clinical studies that have evaluated serotonergic medications to reduce alc ohol consumption have yielded conflicting results. These studies primarily treated patients with alcohol dependence, excluding those with a current de pressive disorder, in an effort to differentiate any medication effects dir ectly on drinking from those on mood. Yet despite the exclusion of current depression, a group of alcohol-dependent patients who are not depressed can be highly heterogeneous. For example, this subgroup can include those with a Lifetime depressive disorder. If these patients were more sensitive to s erotonergic medications than patients without a Lifetime depressive disorde r, medication effects in a subgroup of patients who were not depressed coul d be obscured. Thus, the purpose of this study was to examine the efficacy of sertraline for treating alcohol dependence in patient groups that were d ifferentiated by the presence or absence of Lifetime depression. This study examined the effectiveness of sertraline (200 mg/day) or placebo for 14 we eks in 100 alcohol-dependent subjects with (N = 53) or without (N = 47) a l ifetime diagnosis of comorbid depression. Sertraline treatment seemed to pr ovide an advantage in reducing drinking in alcohol-dependent patients witho ut lifetime depression, illustrated best with a measure of drinking frequen cy during treatment. However, sertraline was no better than placebo in pati ents with a diagnosis of lifetime comorbid depression, and current depressi on did not change the results. Treatment with selective serotonin reuptake inhibitors may be useful in alcohol-dependent patients who are not depresse d. Subtyping those with alcohol dependence on the basis of the absence vers us the presence of a Lifetime depressive disorder may help to resolve confl icting findings in the literature on the treatment of alcohol dependence wi th serotonergic medications.