The Health Center’s addiction unit. Patients enrolling in

The Poorer
Drinking Outcomes with Citalopram Treatment for Alcohol Dependence: A
Randomized, Double-Blind, Placebo-Controlled Trial studied if the Selective
Serotonin Receptor Inhibitor (SSRI) citalopram, an antidepressant medication, would
aid individuals in the treatment of alcohol abuse. The study was conducted at
McGill University Health Center’s addiction unit. Patients enrolling in the addiction
treatment could participate in the study if they were between the years of
18-65 and were diagnosed with alcohol dependency using the Structured Clinical
Interview criteria. Those excluded from the trial were individuals with a
secondary substance abuse problems, individuals suffering from psychotic
disorders, those already taking psychiatric medications including SSRIs or anti-craving
drugs, individuals needing further detoxification or psychiatric admission, individuals
with a family history of adverse reactions to SSRIs, or if they were pregnant
or breastfeeding. Any new prescriptions were also not allowed.1

            A total of 265 subjects enrolled in
the program were randomized into two groups: the placebo and the intervention
group. After the 12 weeks, almost half of the participants withdrew from the
study, leaving the intervention group with 72 subjects and 69 in the placebo
group. The SSRI intervention used was
citalopram 20 mg daily for the first two weeks followed by 40 mg daily for the
remainder of the 12 weeks. To keep the study double blinded, no group distinguishers
were revealed to the clinical research coordinator (CRC) or any participating physicians
and all patients received identical opaque capsules for the treatment. During
the trial, patients were required to attend biweekly appointments with the CRC
for medication distribution, adverse reaction reporting, review of alcohol/drug
diaries, and depression screenings. They were also required to attend one 50-minute
individual psychotherapy appointment as well as one 90 minute group session;
Alcoholics Anonymous was not required but attendance was encouraged. Patients
were monitored for sever adverse reactions, withdrawal symptoms, and mental stability
by the CRC and were removed from the study if further medical attention was
needed. Of the 265 participants 14 or 5% were removed for these reasons.

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Drinking related variables including the number
of drinking days, time to relapse, and abstinence time were measured as primary
outcomes. After completion of the 12-week study, drinks per drinking day, total
number of drinking days during the 12-week period, survey scores, and the patient’s
current status on abstinence were also measured. The results proved that citalopram
in the treatment of alcohol abuse was no more effective than placebo. Subjects
in the citalopram group presented with more heavy drinking days (p=0.007,) more
drinks per day (p=0.03), spent more money on alcohol (p= 0.041), consumed
alcohol more frequently (p= 0.016), and had overall less of a decrease in total
alcohol consumed per drinking day (p=0.025) than those in the placebo group. After
the 12 week assessments, the intervention group also didn’t differ from the
placebo groups in Addiction Severity Index (ASI) scores or psychiatric assessments
either (p > 0.05).

As the results concluded that

             

 

 

 

Another prospective, single blinded,
placebo-controlled study was conducted to see whether the SSRI citalopram in
addition to brief psychosocial interventions (BPIs) are effective in treating
alcohol abuse similarly in non-depressed men and women. Sixty-one subjects
recruited form a newspaper ad and deemed socially and medically stable, who
consumed at lease 28 drinks per week for the past three months and were
categorized as mild-moderate alcohol abusers by the Alcohol Dependence Scale (ADS)
and the Diagnostic and Statistical Manual
of Mental Disorders, 3rd edition, revised (DSM-III-R) were
included in the study (34 men and 27 women). Depressed individuals or those
with psychiatric disorders like anxiety or other dependencies (drug related)
were excluded from the study.

            The 99 subjects were enrolled into the
study however, 38 withdrew due to unrelated problems (57%), missed appointments
(27%), and those who were experiencing possible unspecified adverse reactions
(16%). The remaining 61 subjects began a two-week baseline assessment before being
randomized into two groups. The intervention group, further subdivided into
males and females, received 40 mg citalopram every night at 8 pm in combination
with BPI sessions at weeks 2, 4, 8, and 12; while the control group, also
divided by sex, received the same treatment but with a placebo pill. Two-four
hours after the 8 pm dose, each subject was required to give a urine sample
that was analyzed for riboflavin and ethanol concentrations to confirm the use
of alcohol and medication consumption. Subjects selected individual alcohol
goals of either moderation or abstinence and were monitored for non-alcoholic
drinks, alcoholic drinks, and tobacco use.

The
primary outcome measured was the percent change from baseline in drinks
consumed per day, the secondary outcome measured was the percent change from
baseline in drinks consumed per drinking day, and the third and last outcome
measured was percent total days of abstinence relative to baseline.2 The outcome differences between sexes
were analyzed using a 2-way ANOVA test while Duncan’s post hoc was used to analyze
the specific group differences due to the unequal sample size of men to women.
Depression, anxiety, and alcohol problems were considered covariates. Baseline
measurements concluded women consumed a statistically significant less amount
of alcohol than men and were assessed to have higher anxiety levels. There were
no significant differences between men and women in alcohol cravings or level
of alcohol dependence.

            The results concluded only one statistical
significant outcome. Men receiving citalopram showed a statistically
significant reduction in alcoholic drinks per day than women receiving
citalopram (p=0.045). No significance was found in reduction of drinks per
drinking day between sexes, abstinent days between sexes, or placebo groups
between sexes. Though both men and women receiving citalopram did have greater
reductions in alcohol consumption in comparison to those in the placebo group,
it was not statistically significant.

            The final conclusion to this study
implies that citalopram might be more efficacious in treating men for alcohol
abuse than women, further studies should be completed to confirm this. There
was a lack of information regarding the use of citalopram in both men and women
and this study helped fill that gap in therapy. The authors did a great
background information and research on the subject. This was a conclusive study
design though few outcomes were statistically significant and that could be due
to the small sample size. Power was not included so there is no way to know if
it were met. The treatment groups were adequately selected though the subjects
could be difficult to extrapolate- they were gained by newspaper advertisement and
may not be representative of all that have alcohol abuse, no races were
included and the average age group ranged from 43-50 years old. Might be not
representative but an ethical age group. Also many women who abuse alcohol also
have depression so this is not representative. The study seemed to be correctly
blinded- the subjects did not know of which treatment they were given. In analyzing
the data, the correct statistical tests were used (ANOVA) and the study used the
following  the Alcohol Dependence Scale
(ADS), the Montgomery-Asberg Depression Rating Scale (MADRS), the Michigan
Alcohol Screening Tests (MAST) as well as the State-Trait Anxiety Inventory
test. Due to the fact that there were 4 groups, the data could have been
organized in a more clear fashion. I agree with the author that the only conclusion
was that it may be more effective in men- this is confirmed by the amount of
studies referenced in the need for this differential trial or how men and women
differ in pharmacokinetics which could explain the results. No ethical dilemmas
are in the funding of this trail.