Naltrexone Is Associated With Reduced Drinking by Alcohol Dependent Patients Receiving Antidepressants for Mood and Anxiety Symptoms: Results From VA Cooperative Study No. 425, “Naltrexone in the Treatment of Alcoholism”

Krystal, John H.; Gueorguieva, Ralitza; Cramer, Joyce A.; Rosenheck, Robert A.; Drexler, Karen; Mohammad, Farid; Siklosky, L.; Walker, Katherine C.; Arnold-Hunter, C.; Head, Richard; Hermos, John A.; Behr, Heidi; Kinne, Bridget; Savage, David B.; Wickis, J.; Rugle, Lori; Kausch, Otto; Zegarna, H.; Conti, Kimberly; Adkins, Homer; Harris, Gordon J.; Cartier, Consuelo; Adinoff, Bryon; Burney, L.; Fields, Jessica; Hudson, Barbara L.; Corder, Julie H.; Quintero, Ángela; Grabowski, John J.; Wancha, R.; Ruíz, Yolanda; Chermack, Stephen T.; Fleming, Scott L.; Gamel, K.; Sullivan, Brendan; Madlock, L.; Murray, RM; Williams, James S.; Lewandowski, Robert J.; Owens, Tara; FeBornstein, Marcos; Peña, José M.; Cotton-Brown, B.; Cowie, Megan; Connelly, A.E.; Hill, W.; Holmes, Andrew; Fiery, J.; Casadonte, Paul; Kushner, Stuart; Johnson, Sharon; Siegris, J.; Lynch, NO; Richardson, Edward T.; Butcher, A.; Nixon, Sara Jo; Shaw, Catriona; Joswick, R.; Bertoch, D.; Engebretson, H.; Haynes-Tucker, L.; Moffet, L.; Weintraub, Jane A.; Lutz, Rita; Clinton, Sarah M.; Pohlman, F.; Royal, Robert E.; Harris, Shirley N.; Maany, Iradj; DeStefano, Jean; Andem, M.; Hackett, C.; McNeely, Jennifer; Dyanick, S.; Torpey, Dana C.; Poole, Sabrina; Moeller, Erik M.; Scheamania, A.; Kaplan, Gary B.; MacAskill, Heather S.; Charnley, P.; Williams, Chris; Stock, Christopher; Stevenson, Pamela S.; Plumb, Sandra; Dean, Mary Mischka; Hunter, Jennifer; Banys, Peter; Rhew, Isaac C.; Staccone, Suzanne; Kelly, John F.; Shives, S.; Saxon, Andrew J.; Willey-Allen, M.; Lunna, K.; Ruscigno, V.; Brown, Sarah; Shaffer, K.; Collins, Joseph F.; Kilby, S.; Burke, Tina M.; Linzy, L.; Dalzell, Connie; Rhoads, Margaret; Banks, Nicola; Arflin, J.; Briones, David F.; Król, W; Miller, Melissa A.; Messick, Chad R.

doi:10.1111/j.1530-0277.2007.00555.x

Cited by 20 publications

(11 citation statements)

References 36 publications

(33 reference statements)

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“…The impact of depressive symptoms or depression on naltrexone's effectiveness is not clear, with evidence from some trials suggesting their presence is associated with greater improvements (Kiefer et al, 2003;Krystal et al, 2008;Morley et al, 2010) Naltrexone + psychosocial interventions. The interaction between a number of different psychosocial interventions and naltrexone has been investigated, with no clear advantage of one approach.…”

Section: (Ib)mentioning

confidence: 99%

“…Therefore naltrexone and disulfiram can be used safely in depressed alcoholics with comparable efficacy with those not depressed. Krystal et al (2008) (Ib) undertook a secondary analysis of the VA naltrexone trial where naltrexone failed to show significant advantage over placebo. During the study, about 10% of people required antidepressants since their mood worsened.…”

Section: Relapse Prevention Medication In Depressionmentioning

confidence: 99%

See 1 more Smart Citation

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

Welch²,

et al. 2012

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The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short-and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people. KeywordsSubstance misuse, addiction, guidelines, pharmacotherapy, comorbidity 1 Imperial College London, CNWL NHS Foundation Trust, London, UK 2 Gether NHS Foundation Trust, Gloucester, UK 3 Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UKOther invited participants at the consensus meeting who contributed to the discussion and commented on the guidelines were Drummond C, Farrell M, Gilvarry E, Strang J. John, a user representative, read and commented on the written guidelines. Prof W van den Brink reviewed the written guidelines.

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Section: (Ib)mentioning

confidence: 99%

Section: Relapse Prevention Medication In Depressionmentioning

confidence: 99%

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

Welch²,

et al. 2012

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“…For example, several studies have examined the impact of the opioid antagonist medication naltrexone and the SSRI medication, sertraline. 44, 45, 46, 47 These studies suggest that the combination treatment can lead to higher rates of abstinence from alcohol, longer time to drinking relapse, and improvement in mood relative to those who receive either placebo or antidepressant or AUD pharmacologic interventions alone.…”

Section: Treatment Challengesmentioning

confidence: 98%

Treatment of the Depressed Alcoholic Patient

DeVido

Weiss

2012

Curr Psychiatry Rep

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Alcohol use disorders (AUDs) and depressive illnesses are highly prevalent, frequently co-occur, and are associated with worse outcomes when paired. The assessment and treatment of patients with co-occurring alcohol use disorders and depressive illnesses is wrought with many significant challenges. When it comes to advocating treatment guidelines for this dually diagnosed population, the data are limited, but nonetheless do suggest that an integrated approach to patients presenting with co-occurring AUD and depressive symptoms can be efficacious. In this approach, ongoing evaluation and treatment are provided under one roof according to the evolving needs of each patient. Utilizing antidepressant medications in conjunction with psychosocial therapies may augment overall treatment efficacy; data also suggest that combining and tailoring psychosocial therapies such as motivational enhancement therapies, cognitive therapies, and twelve-step facilitation may further improve treatment outcomes for patients with co-occurring depressive and alcohol use disorders.

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“…A secondary analysis of a randomized trial of naltrexone or placebo for military veterans with alcohol dependence found that the addition of SSRIs among those who developed worsening anxiety or depressive symptoms during the trial did not negatively impact the efficacy of naltrexone for alcohol outcomes. 83 …”

Section: Treatments Targeting the Substance Use Disordermentioning

confidence: 99%

Treatment of Co-occurring Anxiety Disorders and Substance Use Disorders

McHugh

2015

Harvard Review of Psychiatry

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Anxiety disorders co-occur with substance use disorders at a high rate in both the general population and in treatment-seeking samples. The co-occurrence of these disorders is associated with greater symptom severity, higher levels of disability, and poorer course of illness relative to either disorder alone. However, relatively little research focus has been afforded to the treatment of co-occurring anxiety and substance use disorders. This notable gap in the research literature may not only leave anxiety untreated or under-treated, but may also increase the risk for relapse and poor substance use outcomes. The aim of this manuscript is to provide a review of the current state of the literature on the treatment of co-occurring anxiety and substance use disorders. This review includes brief overview of the epidemiology of this co-occurrence, challenges in assessing anxiety in the context of a substance use disorder, evidence for treatment approaches, and new advancements and future directions in this understudied area. The importance of future research to identify optimal behavioral and pharmacologic treatments for co-occurring anxiety and substance use disorders is highlighted.

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Naltrexone Is Associated With Reduced Drinking by Alcohol Dependent Patients Receiving Antidepressants for Mood and Anxiety Symptoms: Results From VA Cooperative Study No. 425, “Naltrexone in the Treatment of Alcoholism”

Abstract: Further investigation will be needed to determine whether naltrexone is efficacious among depressed alcohol dependent patients and whether naltrexone and antidepressant medications show interactive efficacy for treating alcohol dependence.

Cited by 20 publications

References 36 publications

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

Treatment of the Depressed Alcoholic Patient

Treatment of Co-occurring Anxiety Disorders and Substance Use Disorders

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