studied whether the Selective Serotonin ReuptakeInhibitor (SSRI) citalopram, an antidepressant medication, would aid individualsin the treatment of alcohol abuse. The study was conducted at McGill UniversityHealth Center’s addiction unit. Patients enrolling in the addiction treatment couldparticipate in the study if they were between the years of 18-65 and werediagnosed with alcohol dependency using the Structured Clinical Interviewcriteria. Those excluded from the trial were individuals with a secondarysubstance abuse problems, individuals suffering from psychotic disorders, thosealready taking psychiatric medications including SSRIs or anti-craving drugs,individuals needing further detoxification or psychiatric admission, individualswith a family history of adverse reactions to SSRIs, or if they were pregnantor breastfeeding. Any new prescriptions were also not allowed.1 A total of 265 subjects enrolled inthe program were randomized into two groups: the placebo and the interventiongroup.
After the 12 weeks, almost half of the participants withdrew from thestudy, leaving the intervention group with 72 subjects and 69 in the placebogroup. The SSRI intervention used wascitalopram 20 mg daily for the first two weeks followed by 40 mg daily for theremainder of the 12 weeks. To keep the study double blinded, no group distinguisherswere revealed to the clinical research coordinator (CRC) or any participating physiciansand all patients received identical opaque capsules for the treatment. Duringthe trial, patients were required to attend biweekly appointments with the CRCfor medication distribution, adverse reaction reporting, review of alcohol/drugdiaries, and depression screenings.
They were also required to attend one 50-minuteindividual psychotherapy session as well as one 90 minute group session;Alcoholics Anonymous was not required but attendance was encouraged. Patientswere monitored for sever adverse reactions, withdrawal symptoms, and mental stabilityby the CRC and were removed from the study if further medical attention wasneeded. Of the 265 participants 14 or 5% were removed for these reasons. Drinking related variables including the numberof drinking days, time to relapse, and abstinence time were measured as primaryoutcomes.
After completion of the 12-week study, drinks per drinking day, totalnumber of drinking days during the 12-week period, survey scores, and the patient’scurrent status on abstinence were also measured. The results proved that citalopramin the treatment of alcohol abuse was no more effective than placebo. Subjectsin the citalopram group presented with more heavy drinking days (p = 0.007,) moredrinks per day (p = 0.03), spent more money on alcohol (p = 0.
041), consumedalcohol more frequently (p = 0.016), and overall had a smaller decrease intotal alcohol consumed per drinking day (p = 0.025) than those in the placebogroup. After the 12 week assessments, the intervention group also didn’t differfrom the placebo group in Addiction Severity Index (ASI) scores or psychiatricassessments (p > 0.05). It can be concluded from this study thatcitalopram does not aid in the treatment of alcohol abuse however there are somethings to consider.
The external validity could be limited due to the 92% Caucasianethnicity of enrolled participants and the statistically significant baseline differencesbetween the treatment groups. Citalopram subjects were more likely to be unmarried,separated, or divorced (p = 0.039) with a higher need for detoxification priorto the start of the study (p = 0.003) than the placebo group. While the averageage of subjects in the placebo group was 44.7 1.01years and the average age in the intervention group was 46.
0 0.88years the acceptance criteria listed years 18-65 and although it is possible atthe age of 18 to have alcohol dependencies it would be unethical to includethem in this study as they would be under the legal drinking age. Beside theabove points, this study was very well designed, the authors referenced many relevanttrials to the subject, used proper statistical analysis tests, (ANOVA, t-test,and chi squared), and handled missing data appropriately. Another prospective, single blinded,placebo-controlled study was conducted to see whether the SSRI citalopram inaddition to brief psychosocial interventions (BPIs) are effective in treatingalcohol abuse similarly in non-depressed men and women. Sixty-one subjectsrecruited form a newspaper ad and deemed socially and medically stable, whoconsumed at lease 28 drinks per week for the past three months and werecategorized as mild-moderate alcohol abusers by the Alcohol Dependence Scale (ADS)and the Diagnostic and Statistical Manualof Mental Disorders, 3rd edition, revised (DSM-III-R) wereincluded in the study (34 men and 27 women). Depressed individuals or thosewith psychiatric disorders like anxiety or other dependencies (drug related)were excluded from the study. The 99 subjects were enrolled into thestudy however, 38 withdrew due to unrelated problems (57%), missed appointments(27%), and those who were experiencing possible unspecified adverse reactions(16%).
The remaining 61 subjects began a two-week baseline assessment before beingrandomized into two groups. The intervention group, further subdivided intomales and females (15 women and 16 men), received 40 mg citalopram every nightat 8 pm in combination with BPI sessions at weeks 2, 4, 8, and 12; while the controlgroup, also divided by sex (12 women and 18 men), received the same treatmentbut with a placebo pill. Two-four hours after the 8 pm dose, each subject wasrequired to give a urine sample that was analyzed for riboflavin and ethanolconcentrations to confirm the use of alcohol and medication consumption.
Subjectsselected individual alcohol goals of either moderation or abstinence and weremonitored for non-alcoholic drinks, alcoholic drinks, and tobacco use. The primary outcome measured was the percentchange from baseline in drinks consumed per day, the secondary outcome measuredwas the percent change from baseline in drinks consumed per drinking day, andthe third and last outcome measured was percent total days of abstinence relativeto baseline.2 The outcome differences between sexes were analyzedusing a 2-way ANOVA test while Duncan’s post hoc was used to analyze thespecific group differences due to the unequal sample size of men to women.Depression, anxiety, and alcohol problems were considered covariates.
Baselinemeasurements concluded women consumed a statistically significant less amountof alcohol than men and were assessed to have higher anxiety levels. There wereno significant differences between men and women in alcohol cravings or levelof alcohol dependence. Only one statistical significant primary outcome wasconcluded from this study. Men receiving citalopram showed a statisticallysignificant reduction in alcoholic drinks per day than women receivingcitalopram (p=0.
045). No significance was found in reduction of drinks perdrinking day between sexes, abstinent days between sexes, or placebo groupsbetween sexes. Though both men and women receiving citalopram did have greaterreductions in alcohol consumption in comparison to those in the placebo group,it was not statistically significant.