Zoloft Not for Every Alcoholic
Antidepressant doesn't help those with more severe problem
WEDNESDAY, July 14, 2004 (HealthDayNews) -- While not prescribed to treat alcoholism itself, antidepressants are often given to help relieve the depression that often accompanies the problem.
But for some hard-core alcoholics, the common antidepressant Zoloft (sertraline) appears to have no beneficial effect and may even cause increased drinking, a new study finds.
Zoloft is a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI), which helps maintain optimal levels of serotonin, an important neurotransmitter linked to depression.
"We found that type A alcoholics responded to Zoloft along with 12-step individual therapy," said study author William Dundon, a senior research investigator in the department of psychiatry at the University of Pennsylvania School of Medicine.
However, with type B alcoholics, Zoloft didn't seem to have any effect, Dundon added.
According to Dundon, type B alcoholics are those with the most severe drinking problem. Compared to type A alcoholics, they tend to drink more, have an earlier history of drinking or other drug abuse, and had higher levels of depression.
In their study, Dundon's team did a six-month follow-up of 100 alcoholics who had participated in an earlier trial. In that trial, the subjects were given Zoloft or a dummy drug plus an individual 12-step therapy program. This treatment combination continued for three months.
The research team found that the 55 type A alcoholics who had received Zoloft maintained the positive results they had achieved during treatment, Dundon said.
However, the 45 type B alcoholics who received Zoloft continued to show no benefit from the drug. In fact, heavy drinking increased, he added.
Their report appears in the July issue of Alcoholism: Clinical and Experimental Research.
Why Zoloft is not effective in type B alcoholics is not known, Dundon said.
"This and other studies show that SSRIs may be helpful for the type As, but may not be indicated for the type Bs," Dundon said. Right now, there is no simple way of telling who is a type A and who is a type B, he noted.
"For treating alcoholism, we always recommend that treatment include psychotherapy and medication and involvement in a twelve-step program," Dundon said. This combination is the most effective regardless of whether one is a type A or type B alcoholic, he noted.
"This study suggests that we need to look carefully at people with severe alcohol dependence," said Dr. Darlene H. Moak, an assistant professor of psychiatry at the Medical University of South Carolina.
Moak believes that an easy way to classify patients as type A or type B is to ask when they first started having problems with alcohol. "If it is before [age] 25, that is considered early-onset. If it's after 25, it's later-onset," she said.
For those with early-onset alcohol problems, Moak said she might prescribe Zoloft, but monitor these patients carefully.
There is a concern that an SSRI might increase the desire to drink among type B alcoholics, Moak said. "These patients probably have more serotonin dysfunction. By putting them on an SSRI, it may be too much, too quickly and overload their underused serotonin system," she said.
"We need to be cautious prescribing SSRIs to individuals with early-onset alcohol problems," Moak advised.
"There might be some predictive utility to dividing alcohol dependence into type A and type B," said Dr. Mark S. Gold, chief of the McKnight Brain Institute at the University of Florida. "Identifying types of alcoholics might help predict who could respond to what treatment."
The National Institute on Alcohol Abuse and Alcoholism can tell you about treatments for alcoholism.