Sertraline treatment of comorbid posttraumatic stress disorder and alcohol dependence

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 12/1995; 56(11):502-5.
Source: PubMed


Posttraumatic stress disorder (PTSD) often co-occurs with alcohol dependence, yet little is known about treatment of this comorbidity. The serotonin selective reuptake inhibitors have been shown preliminarily to be effective in decreasing symptoms of PTSD but have not been studied in individuals with comorbid alcohol dependence. This is of particular interest as the SSRIs also have a modest effect in decreasing alcohol consumption.
In this preliminary trial, nine subjects with comorbid PTSD and alcohol dependence were treated in an open-label trial with sertraline for a 12-week period. Symptoms of PTSD and depression were monitored monthly with the Impact of Event Scale and the Hamilton Rating Scale for Depression (HAM-D). Alcohol consumption was monitored by a self-report instrument (Time-Line Follow-Back).
There were significant decreases in all three symptom clusters of PTSD measured by overall PTSD symptom scores (p < or = .001) and in HAM-D scores (p < or = .001) during the follow-up period. Days of abstinence increased and average number of drinks decreased during the follow-up period. Four subjects claimed total abstinence during the follow-up period.
While limited by small sample size and the open-label, nonblinded study design, this study suggests that sertraline may be useful in the treatment of PTSD complicated by alcoholism. The medication was well tolerated and subjects showed improvement in PTSD symptoms as well as decreased alcohol consumption. A controlled trial of sertraline in this population would be of interest.

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    • "Sertraline, a serotoninspecific reuptake inhibitor, has been investigated in patients with comorbid alcohol dependence and PTSD. The first study was a small (n = 9) open-label, 12-week trial, which demonstrated significant pre–post decreases in alcohol use severity (e.g., number of drinking days, number of drinks per day), as well as PTSD symptoms of re-experiencing the trauma, avoidance, and hyperarousal (Brady et al. 1995). A second study examined the efficacy of 12 weeks of sertraline compared with placebo in 94 patients with alcohol dependence and PTSD (Brady et al. 2005). "
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    • "The efficacy of these medications may be more robust in non-veteran and predominately female patient populations (Hertzberg et al, 1999; Smajkic et al, 2001), including a negative clinical trial in predominately male veterans (Friedman et al, 2007). Although an openlabel study suggested that sertraline reduced PTSD symptoms and alcohol consumption (Brady et al, 1995), a larger randomized, placebo controlled study (n ¼ 94) showed no significant overall effect of sertraline on symptoms of PTSD or alcohol consumption (Brady and Sinha, 2005). "
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    • "While the exact role of serotonin in PTSD is not fully understood, SSRIs have been used to treat PTSD effectively. For PTSD with concurrent A/ SUD, an open label preliminary study of sertraline with nine participants showed PTSD symptom and alcohol intake reduction (Brady et al., 1995). In one of only two RCTs of pharmacological treatment for comorbid PTSD and A/SUD, Brady and colleagues (2005) randomly assigned 94 individuals with PTSD and alcohol dependence to sertraline or placebo using a double blind design. "
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