Efecto de la depresión en los resultados de un ensayo clínico que evalúan los antidepresivos +/- naltrexona para el tratamiento de la dependencia del alcohol y trastorno de estrés postraumático

INTRODUCTION:

Alcohol dependence (AD) and posttraumatic- stress disorder (PTSD) frequently cooccur and the presence of comorbidity affects treatment outcomes of both alcohol use outcomes and PTSD symptoms. Depression also co-occurs with each of those disorders at a high frequency. Using data collected in amulti-site clinical trial evaluating the efficacy of different classes of antidepressants (noradrenergic vs. serotonergic) in the treatment of veterans with comorbid AD and PTSD, we wished to test whether the presence of a current depressive disorder influenced the outcomes.

OBJECTIVE:

We conducted a secondary analysis of results from a study that was designed to evaluate the efficacy of desipramine vs. paroxetine in combination with naltrexone vs. placebo in reducing drinking, depression and PTSD symptoms in those with comorbid AD and PTSD. This study tested whether the presence or absence of depression influenced the outcomes.

METHODS:

Veterans diagnosed with alcohol dependence and comorbid PTSD (n = 88) were randomly assigned under double-blind conditions to one of four treatment groups: paroxetine + naltrexone; paroxetine + placebo; desipramine + naltrexone; desipramine + placebo. Of those, n = 31 had AD and PTSD alone and n = 57 had AD, PTSD and a comorbid depressive disorder. Outcomes included alcohol usemeasures (drinking days, heavy drinking days using the Time Line FollowBack Method and craving scores using the OCDS), symptoms of PTSD (using CAPS data) andmeasures of depression (Hamilton Depression Scale).

RESULTS:

The participants in this study were predominately male (90.1%), with a mean age=47.1 (SD=8.9), predominately Caucasian (75%). Of the 88 randomized, n = 49 or 55.7%completed the entire trial. Overall results suggest a significant antidepressant effect; desipramine was significantly more effective than paroxetine in reducing the average alcohol drinking (average number of drinks per week and percent heavy drinking days). The presence of depression affected outcome: in the group of veterans without depression alcohol use outcomes were similar between groups. In the group with comorbid depression desipramine wasmore effective (p < 0.05).

CONCLUSION:

These results suggest that noradrenergic medications may be effective in decreasing alcohol use outcomes among individuals with AD and comorbid PTSD particularly in those with comorbid depression.