Depression Alcohol Dependence Combination Therapy

There was an interesting stucdy in the March isssue of the American Journal of Pysychiatry that looked at combining medication treatment for those alcohol dependent patients who also suffered from co-occurring major depression. This study is important for one conclusion but as I have noted before with various studies the researchers often come to other conclusions that are not necessarily supported by their own evidence.

170 depressed alcohol dependent patients (mean 43.4 years of age) were randomly assigned to 14 weeks of the antidepressant sertraline (Zoloft) at 200 mg/day (the maximum dose), to the alcohol dependence drug naltrexone(Revia), to both drugs, or to double placebo groups and studied for a period of 14 weeks. All patients received weekly cognitive-behavioral therapy. The important finding was that at the end of 14 weeks 53% in the sertraline-naltrexone group maintained abstinence compared with an average of 23.8% for the other three treatments. This is very striking and may have significant implications for how we treat depressed alcoholics. Limitations of the study are the relatively small number of participants and the time frame of the study (3 1/2 months). But this is an important finding and one in which I hope there will be more follow-up for a longer period of time, enroll more patients, and separate out differences between men and women as well as those who received inpatient treatment compared with those were did not.

The other point they try to make in this study is that those receiving both treatments were less depressed than those with sertraline alone. They try to make the the point that there was a trend in that direction but the trend did not reach statistical significance. Reporting and highlighting trends that are not statistically significant is often a problem in that these results get reported in the media as important findings as well as the main findings and people come to conclusions that are not really supported by the evidence.

So in this case the improved abstinence rates at 3 1/2 months for the combined group is extremely important but we cannot say at this time that the combined treatment actually helps the depression.

Thought for the day

53% abstinence in a population with a co -occurring and serious psychiatric disorder is encouraging.

Alcohol, Breast Cancer, Million Women Study, UK

We all know that alcohol use is associated with a variety of health risks. We are also told however that low use of alcohol(one to two drinks per day) gives some cardiac protection and can lower the risk of heart disease. Recent findings from the Million Women Study in the United Kingdom show that there are other adverse effects that we need to be aware of.

1.3 million women, average age 55, have been followed for the past seven years and it is clear that alcohol use, even mild can increase the risk of cancer, particularly breast cancer. The study found that the risk exists even with one drink per day and increases with increasing use. It is estimated that 1 drink per day resulted in an increase of 15 cancers per 1000 women and that two drinks per day caused 30 more new cancer cases per 1000 women. This might not seem like a lot but translates into approximately 13% of all new cancer cases in women may be directly attributable to alcohol. In addition to breast cancer there was an increase in rectal and liver cancers and in women who smoked esophageal and oral cancers as well.

This is a reminder to me that sweeping recommendations such as drink a little to reduce heart disease have to be balanced by other factors and that we need to look at overall health in evaluating any forms of prevention and treatment.

Thought for the day

"Fools despise wisdom and instruction".

The book of Proverbs