Antidepressants for Co-Occurring Depression and Alcohol Dependence

Summary

A Cochrane review [Abstract] 1 included 33 studies with a total of 2 242 subjects. Antidepressants (sertraline, amitriptyline, citalopram, desipramine, doxepin, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazepine, nefazodone, paroxetine, tianeptine, venlafaxine, and viloxazine) were compared to placebo, psychotherapy, other medications, or other antidepressants. The mean duration of the trials was 9.9 weeks (range 3 to 26 weeks). Compared to placebo, antidepressants reduced the severity of depression evaluated with interviewer-rated scales. However, the difference became non-significant after the exclusion of studies with a high risk of bias (SMD -0.17, 95% CI -0.39 to 0.04). Antidepressants suggested an increase in the response to the treatment (table T1), but again the result became non-significant after the exclusion of studies at high risk of bias (RR 1.27, 95% CI 0.96 to 1.68). Antidepressants increased the number of participants abstinent from alcohol during the trial and reduced the number of drinks per drinking days (table T1). There were no differences between antidepressants and placebo in the number of dropouts and adverse events as withdrawal for medical reasons.