Article

Naltrexone and disulfiram in patients with alcohol dependence and current depression

Department of Psychiatry, Yale University, New Haven, Connecticut, United States
Journal of Clinical Psychopharmacology (Impact Factor: 3.76). 05/2007; 27(2):160-5. DOI: 10.1097/jcp.0b13e3180337fcb
Source: PubMed

ABSTRACT Although disulfiram and naltrexone have been approved by the Food and Drug Administration for the treatment of alcoholism, no medications have been approved for individuals with alcohol dependence and comorbid psychiatric disorders. In particular, the effect of these medications on alcohol use outcomes and on specific psychiatric symptoms is still unknown in patients with the most common co-occurring disorder, major depression.
Two hundred fifty-four patients with a major Axis I psychiatric disorder and comorbid alcohol dependence were treated for 12 weeks in an outpatient medication study conducted at 3 Veterans Administration outpatient clinics. Randomization included (1) open randomization to disulfiram or no disulfiram, and (2) double-blind randomization to naltrexone or placebo. This resulted in 4 groups: (1) naltrexone alone, (2) placebo alone, (3) disulfiram and naltrexone, and (4) disulfiram and placebo. Primary outcomes were measures of alcohol use. Secondary outcomes included psychiatric symptoms assessed by the Hamilton Depression Rating Scale, alcohol craving, gamma-glutamyltransferase levels, and adverse events.
One hundred thirty-nine subjects (54.7%) met the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for major depression. There was no relationship between the diagnosis of depression and medication treatment on alcohol use outcomes, psychiatric symptoms, or the reporting of side effects for these medications. There was a significant interaction between diagnosis, medication group, and craving, where subjects with depression on disulfram reported lower craving over time than subjects with depression on naltrexone.
The results suggest that disulfiram and naltrexone are safe pharmacotherapeutic agents for dually diagnosed individuals with depression for the treatment of alcohol use disorders.

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    ABSTRACT: INTRODUCTION Although alcoholism is a severe public health problem having a worldwide impact, there are a limited number of pharmacological interventions used for its treatment. OBJECTIVES To evaluate the contribution of disulfiram use for retention of alcohol-dependent outpatients in treatment with focus on gender. METHODS This is a retrospective cross-sectional study using a sample of 810 alcohol-dependent patients (652 men and 158 women) who attended the clinic between 2000 and 2006. The patients were divided into three groups depending on their treatment retention. RESULTS A greater concentration of men and women who took the aversive medication among the patients remained longer in treatment. CONCLUSION Disulfiram is an instrument that can contribute to improve retention in outpatient treatment, but this approach should be viewed as part of a complex and dynamic therapeutic process.