Starting Treatment with Both Sertraline and Naltrexone for Depressed Alcoholics

Major depression frequently co-occurs with alcohol dependence. Clinicians have had little evidence-based guidance for deciding whether to treat the depression immediately or to wait to see the clinical picture that emerges after alcohol dependence has resolved. These investigators conducted a federally funded, single-site, randomized, controlled trial of 170 outpatients with major depression and alcohol dependence.

Patients were assigned to 14 weeks of sertraline (starting dose, 50 mg/day; maximum, 200 mg/day), naltrexone (starting dose, 50 mg; maximum, 100 mg/day), combined naltrexone and sertraline (N+S), or placebo. Patients had support group meetings and weekly cognitive-behavioral therapy (CBT) for substance abuse that was adapted to also help depression. The treatment groups had similar rates of medication adherence (overall, 87%); mean attendance of CBT sessions was 59%. During the trial, 43% of patients discontinued prematurely for social or clinical reasons, with no between-group differences.

At the end of treatment, intent-to-treat analyses showed that the N+S group had a significantly higher percentage of patients who were abstinent for 14 weeks than the other three groups combined (54% vs. 24%) and took significantly longer to relapse to heavy drinking (64 vs. 42 days). Again compared with the other treatment groups combined, the N+S group showed a nonsignificant trend toward a greater percentage of patients not depressed at the end of treatment (58% vs. 83%).