Adamson 2015: adding citalopram to naltrexone for depression and drinking

What they tested

138 adults with major depression and alcohol dependence were randomly assigned to citalopram or a placebo for 12 weeks. Everyone also took naltrexone and had clinical case management. They didn't have to stop drinking before starting.

The researchers also checked whether sex, or the type of depression (independent of drinking or brought on by it), changed how people responded.

What they found

Mood and drinking improved substantially in both groups. There was no significant difference between citalopram and placebo on any mood or drinking measure, whether or not other factors were taken into account.

The type of depression made no difference to response. Women taking citalopram did better on one drinking measure, percent of days abstinent, but this effect was marginal and the authors called the findings for sex equivocal.

Treatment was well attended, the medicines were reasonably well tolerated, and adherence was high. The authors concluded that citalopram is not a clinically useful addition to naltrexone and case management in this group.

Limits

• No group went without naltrexone, so the trial can't show how much of the improvement came from naltrexone itself.
• It lasted 12 weeks, so it can't show longer-term effects on mood or drinking.
• The finding in women was marginal, and the authors called the results by sex equivocal.

What it means if you're considering naltrexone

For someone with depression who is considering naltrexone for drinking, this trial found that both groups improved a lot on naltrexone plus case management, and that adding citalopram didn't add to that. The two medicines were taken together and were reasonably well tolerated. It tested one antidepressant over 12 weeks, so it doesn't settle whether other antidepressants would help.