Zoloft Not for Every Alcoholic...

July 14, 2004

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Zoloft Not for Every Alcoholic

By Reinberg

HealthDay Reporter

WEDNESDAY, July 14 (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 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. "

July 14, 2004