Pettinati 2010: sertraline plus naltrexone for depression and drinking

What they tested

Patients were randomly assigned to 14 weeks of sertraline (an antidepressant) 200 mg a day, naltrexone 100 mg a day, both, or two placebos (dummy pills). Neither patients nor staff knew who had what. Everyone also had weekly cognitive behavioral therapy.

Group sizes were 40 on sertraline, 49 on naltrexone, 42 on the combination and 39 on placebo. The team measured abstinence, time to relapse to heavy drinking, depression and serious adverse events.

What they found

The combination group had the highest abstinence rate (53.7%) and the longest median delay before relapse to heavy drinking (98 days). The other groups: naltrexone, 21.3% and 29 days; sertraline, 27.5% and 23 days; placebo, 23.1% and 26 days.

By the end of treatment, 83.3% of the combination group were not depressed. Compared with the other groups, this difference approached but did not reach statistical significance.

Serious adverse events occurred in 25.9% of patients overall, and less often on the combination (11.9%) than on the other treatments.

Limits

• Groups were small, with 39 to 49 people each.
• Naltrexone was given at 100 mg a day, double the usual 50 mg dose, so results may not match standard use.
• The benefit on depression didn't reach statistical significance, and the trial lasted 14 weeks.

What it means if you're considering naltrexone

For someone with depression as well as a drinking problem, this trial suggests naltrexone may work better alongside an antidepressant like sertraline than on its own. Naltrexone alone did no better than placebo on abstinence here.

It also found fewer serious adverse events on the two drugs together, which the site's guide on what to avoid on naltrexone uses as evidence about combining them. Decisions about adding an antidepressant are for a prescriber.