Findings emerging from the TEAM (Treatment Evaluation of Alcohol and Mood) study in Christchurch are set to challenge current practice when treating depression in alcohol-dependent people.
Professor Doug Sellman, who is the director of the National Addiction Centre at the University of Otago Christchurch School of Medicine and Health Sciences, says their key question was whether people with this "double pathology" do better with an antidepressant in addition to the anti-craving medication naltrexone.
They recruited 141 people to the national multisite study to compare outcomes for those given the antidepressant citalopram as well naltrexone, with those who received a placebo along with their anti-craving medication.
The study was funded by the Health Research Council of New Zealand.
“We were interested in whether the combined medication helped people's alcohol use as well,” explains Professor Sellman.
“Everyone in the study also received conscientious clinical case management (CCM), focused on support for taking the medications, dealing with side-effects and assisting people with problems in their lives.”
Professor Sellman says the main paper is under review at present so he cannot be specific about the findings yet, “but we can report that using citalopram in addition to naltrexone and CCM is not as effective as you might anticipate compared with those who received naltrexone and CCM alone.”
He says the findings will certainly challenge current practice which generally involves giving such patients antidepressants for their depression.
“Hopefully, the findings will shift clinical practice towards more actively assisting people to reduce and, ideally, stop drinking alcohol altogether in this situation.”
“Further, it adds to the argument that naltrexone should be made more available to people with alcoholism in New Zealand. At the present time it can only be accessed through specialised drug clinics and not through general practice.”
Professor Sellman says a secondary question of the study was whether the combination of medications had a differential effect depending on whether the depression was “primary” or “secondary”.
“Traditionally, primary depression is the sort of depression that was there before the person became alcoholic and would probably have occurred even if the person wasn't alcoholic. However, secondary depression is traditionally thought of as being directly associated with heavy drinking, so that once heavy drinking is reduced and ideally stopped, the depression will resolve spontaneously.”
“Our findings did not find a differential effect for these two types of depression and adds to the increasing scepticism about the validity of such a dichotomous concept.”
Professor Sellman says research investigating “alcoholic depression” on a continuum, including genetic markers in addition to clinical phenomena and historical data is likely to be a fruitful area for future research. This could also include researching the use of further medications in assisting people with "alcoholic depression", particularly at the outset of their recovery from alcoholism.