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"

John H. Krystal, Ralitza Gueorguieva, Joyce Cramer, Joseph Collins, Robert Rosenheck, K. Drexler, F. Mohammad, L. Siklosky, K. Walker, C. Arnold-Hunter, R. Head, J. Hermos, H. Behr, B. Kinne, D. Savage, J. Wickis, L. Rugle, O. Kausch, H. Zegarna, K. ContiH. Adkins, G. Harris, C. Cartier, B. Adinoff, L. Burney, J. Fields, B. Hudson, J. Corder, A. Quintero, J. Grabowski, R. Wancha, Y. Ruiz, S. Chermack, S. Fleming, K. Gamel, B. Sullivan, L. Madlock, R. Murray, J. Williams, R. Lewandowski, T. Owens, M. FeBornstein, J. Pena, B. Cotton-Brown, M. Cowie, A. Connelly, W. Hill, A. Holmes, J. Fiery, P. Casadonte, S. Kushner, S. Johnson, J. Siegris, N. Lynch, E. Richardson, A. Butcher, S. Nixon, C. Shaw, R. Joswick, D. Bertoch, H. Engebretson, L. Haynes-Tucker, L. Moffet, J. Weintraub, R. Lutz, S. Clinton, F. Pohlman, R. Royal, S. Harris, I. Maany, J. DeStefano, M. Andem, C. Hackett, J. McNeely, S. Dyanick, D. Torpey, S. Poole, E. Moeller, A. Scheamania, G. Kaplan, H. MacAskill, P. Charnley, C. Williams, C. Stock, P. Stevenson, S. Plumb, M. Dean, J. Hunter, P. Banys, I. Rhew, S. Staccone, J. Kelly, S. Shives, A. Saxon, M. Willey-Allen, J. Williams, K. Lunna, V. Ruscigno, S. Brown, K. Shaffer, J. Collins, S. Kilby, T. Burke, L. Linzy, C. Dalzell, M. Rhoads, J. Kelly, N. Banks, J. Arflin, D. Briones, W. Krol, M. Miller, C. Messick

Research output: Contribution to journalArticle

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Abstract

Background: It is not clear whether naltrexone is effective in reducing alcohol consumption among patients with clinically significant mood symptoms and whether naltrexone favorably interacts with antidepressant medications when they are co-prescribed. Methods: This study reflects a secondary analysis of the first 13 weeks of VA CSP #425, a study that evaluated the efficacy of naltrexone 50 mg/d in 627 alcohol dependent military veterans receiving Twelve Step Facilitation therapy at 20 VA Medical Centers. This study included patients with comorbid mood and anxiety disorders, providing they did not need treatment for these comorbid conditions at the time of study entry. Sixty patients developed sufficiently severe mood symptoms while on study medication that they required antidepressant treatment. This analysis evaluated whether the efficacy of naltrexone and placebo was influenced by the prescription of antidepressant medications to some study patients for their mood and anxiety symptoms. Results: In patients randomized to placebo (n = 209), prescription of antidepressants was associated with a significantly higher percentage of drinking days (lsmean = 24.4, se = 4.85 vs. lsmean = 12.9, se = 1.69, p = 0.02). Although the group of patients receiving naltrexone (n = 418) was larger than the group assigned to placebo, there were no significant differences in drinking-related outcomes in the groups who did or did not receive antidepressants (lsmean = 11.5, se = 1.18 vs. lsmean = 12.9, se = 1.69, p = 0.47). Among the group of patients receiving antidepressants, naltrexone prescription was associated with a reduction in the percent drinking days compared to placebo [lsmean = 10.1, se = 3.47 vs. lsmean = 24.4, se = 4.85, F(1,556) = 5.84, p = 0.02]. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)85-91
Number of pages7
JournalAlcoholism: Clinical and Experimental Research
Volume32
Issue number1
DOIs
StatePublished - Jan 2008

Fingerprint

Naltrexone
Alcohol Drinking
Antidepressive Agents
Alcoholism
Anxiety
Alcohols
Placebos
Drinking
Prescriptions
Therapeutics
Time and Motion Studies
Veterans
Anxiety Disorders
Mood Disorders

Keywords

  • Alcohol Dependence
  • Antidepressants
  • Depression
  • Mood Disorder
  • Naltrexone
  • Treatment

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Toxicology

Cite this

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; Collins, Joseph; Rosenheck, Robert; Drexler, K.; Mohammad, F.; Siklosky, L.; Walker, K.; Arnold-Hunter, C.; Head, R.; Hermos, J.; Behr, H.; Kinne, B.; Savage, D.; Wickis, J.; Rugle, L.; Kausch, O.; Zegarna, H.; Conti, K.; Adkins, H.; Harris, G.; Cartier, C.; Adinoff, B.; Burney, L.; Fields, J.; Hudson, B.; Corder, J.; Quintero, A.; Grabowski, J.; Wancha, R.; Ruiz, Y.; Chermack, S.; Fleming, S.; Gamel, K.; Sullivan, B.; Madlock, L.; Murray, R.; Williams, J.; Lewandowski, R.; Owens, T.; FeBornstein, M.; Pena, J.; Cotton-Brown, B.; Cowie, M.; Connelly, A.; Hill, W.; Holmes, A.; Fiery, J.; Casadonte, P.; Kushner, S.; Johnson, S.; Siegris, J.; Lynch, N.; Richardson, E.; Butcher, A.; Nixon, S.; Shaw, C.; Joswick, R.; Bertoch, D.; Engebretson, H.; Haynes-Tucker, L.; Moffet, L.; Weintraub, J.; Lutz, R.; Clinton, S.; Pohlman, F.; Royal, R.; Harris, S.; Maany, I.; DeStefano, J.; Andem, M.; Hackett, C.; McNeely, J.; Dyanick, S.; Torpey, D.; Poole, S.; Moeller, E.; Scheamania, A.; Kaplan, G.; MacAskill, H.; Charnley, P.; Williams, C.; Stock, C.; Stevenson, P.; Plumb, S.; Dean, M.; Hunter, J.; Banys, P.; Rhew, I.; Staccone, S.; Kelly, J.; Shives, S.; Saxon, A.; Willey-Allen, M.; Williams, J.; Lunna, K.; Ruscigno, V.; Brown, S.; Shaffer, K.; Collins, J.; Kilby, S.; Burke, T.; Linzy, L.; Dalzell, C.; Rhoads, M.; Kelly, J.; Banks, N.; Arflin, J.; Briones, D.; Krol, W.; Miller, M.; Messick, C.

In: Alcoholism: Clinical and Experimental Research, Vol. 32, No. 1, 01.2008, p. 85-91.

Research output: Contribution to journalArticle

Krystal, JH, Gueorguieva, R, Cramer, J, Collins, J, Rosenheck, R, Drexler, K, Mohammad, F, Siklosky, L, Walker, K, Arnold-Hunter, C, Head, R, Hermos, J, Behr, H, Kinne, B, Savage, D, Wickis, J, Rugle, L, Kausch, O, Zegarna, H, Conti, K, Adkins, H, Harris, G, Cartier, C, Adinoff, B, Burney, L, Fields, J, Hudson, B, Corder, J, Quintero, A, Grabowski, J, Wancha, R, Ruiz, Y, Chermack, S, Fleming, S, Gamel, K, Sullivan, B, Madlock, L, Murray, R, Williams, J, Lewandowski, R, Owens, T, FeBornstein, M, Pena, J, Cotton-Brown, B, Cowie, M, Connelly, A, Hill, W, Holmes, A, Fiery, J, Casadonte, P, Kushner, S, Johnson, S, Siegris, J, Lynch, N, Richardson, E, Butcher, A, Nixon, S, Shaw, C, Joswick, R, Bertoch, D, Engebretson, H, Haynes-Tucker, L, Moffet, L, Weintraub, J, Lutz, R, Clinton, S, Pohlman, F, Royal, R, Harris, S, Maany, I, DeStefano, J, Andem, M, Hackett, C, McNeely, J, Dyanick, S, Torpey, D, Poole, S, Moeller, E, Scheamania, A, Kaplan, G, MacAskill, H, Charnley, P, Williams, C, Stock, C, Stevenson, P, Plumb, S, Dean, M, Hunter, J, Banys, P, Rhew, I, Staccone, S, Kelly, J, Shives, S, Saxon, A, Willey-Allen, M, Williams, J, Lunna, K, Ruscigno, V, Brown, S, Shaffer, K, Collins, J, Kilby, S, Burke, T, Linzy, L, Dalzell, C, Rhoads, M, Kelly, J, Banks, N, Arflin, J, Briones, D, Krol, W, Miller, M & Messick, C 2008, '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"', Alcoholism: Clinical and Experimental Research, vol. 32, no. 1, pp. 85-91. https://doi.org/10.1111/j.1530-0277.2007.00555.x
Krystal, John H. ; Gueorguieva, Ralitza ; Cramer, Joyce ; Collins, Joseph ; Rosenheck, Robert ; Drexler, K. ; Mohammad, F. ; Siklosky, L. ; Walker, K. ; Arnold-Hunter, C. ; Head, R. ; Hermos, J. ; Behr, H. ; Kinne, B. ; Savage, D. ; Wickis, J. ; Rugle, L. ; Kausch, O. ; Zegarna, H. ; Conti, K. ; Adkins, H. ; Harris, G. ; Cartier, C. ; Adinoff, B. ; Burney, L. ; Fields, J. ; Hudson, B. ; Corder, J. ; Quintero, A. ; Grabowski, J. ; Wancha, R. ; Ruiz, Y. ; Chermack, S. ; Fleming, S. ; Gamel, K. ; Sullivan, B. ; Madlock, L. ; Murray, R. ; Williams, J. ; Lewandowski, R. ; Owens, T. ; FeBornstein, M. ; Pena, J. ; Cotton-Brown, B. ; Cowie, M. ; Connelly, A. ; Hill, W. ; Holmes, A. ; Fiery, J. ; Casadonte, P. ; Kushner, S. ; Johnson, S. ; Siegris, J. ; Lynch, N. ; Richardson, E. ; Butcher, A. ; Nixon, S. ; Shaw, C. ; Joswick, R. ; Bertoch, D. ; Engebretson, H. ; Haynes-Tucker, L. ; Moffet, L. ; Weintraub, J. ; Lutz, R. ; Clinton, S. ; Pohlman, F. ; Royal, R. ; Harris, S. ; Maany, I. ; DeStefano, J. ; Andem, M. ; Hackett, C. ; McNeely, J. ; Dyanick, S. ; Torpey, D. ; Poole, S. ; Moeller, E. ; Scheamania, A. ; Kaplan, G. ; MacAskill, H. ; Charnley, P. ; Williams, C. ; Stock, C. ; Stevenson, P. ; Plumb, S. ; Dean, M. ; Hunter, J. ; Banys, P. ; Rhew, I. ; Staccone, S. ; Kelly, J. ; Shives, S. ; Saxon, A. ; Willey-Allen, M. ; Williams, J. ; Lunna, K. ; Ruscigno, V. ; Brown, S. ; Shaffer, K. ; Collins, J. ; Kilby, S. ; Burke, T. ; Linzy, L. ; Dalzell, C. ; Rhoads, M. ; Kelly, J. ; Banks, N. ; Arflin, J. ; Briones, D. ; Krol, W. ; Miller, M. ; Messick, C. / 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". In: Alcoholism: Clinical and Experimental Research. 2008 ; Vol. 32, No. 1. pp. 85-91.
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abstract = "Background: It is not clear whether naltrexone is effective in reducing alcohol consumption among patients with clinically significant mood symptoms and whether naltrexone favorably interacts with antidepressant medications when they are co-prescribed. Methods: This study reflects a secondary analysis of the first 13 weeks of VA CSP #425, a study that evaluated the efficacy of naltrexone 50 mg/d in 627 alcohol dependent military veterans receiving Twelve Step Facilitation therapy at 20 VA Medical Centers. This study included patients with comorbid mood and anxiety disorders, providing they did not need treatment for these comorbid conditions at the time of study entry. Sixty patients developed sufficiently severe mood symptoms while on study medication that they required antidepressant treatment. This analysis evaluated whether the efficacy of naltrexone and placebo was influenced by the prescription of antidepressant medications to some study patients for their mood and anxiety symptoms. Results: In patients randomized to placebo (n = 209), prescription of antidepressants was associated with a significantly higher percentage of drinking days (lsmean = 24.4, se = 4.85 vs. lsmean = 12.9, se = 1.69, p = 0.02). Although the group of patients receiving naltrexone (n = 418) was larger than the group assigned to placebo, there were no significant differences in drinking-related outcomes in the groups who did or did not receive antidepressants (lsmean = 11.5, se = 1.18 vs. lsmean = 12.9, se = 1.69, p = 0.47). Among the group of patients receiving antidepressants, naltrexone prescription was associated with a reduction in the percent drinking days compared to placebo [lsmean = 10.1, se = 3.47 vs. lsmean = 24.4, se = 4.85, F(1,556) = 5.84, p = 0.02]. Conclusions: 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.",
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author = "Krystal, {John H.} and Ralitza Gueorguieva and Joyce Cramer and Joseph Collins and Robert Rosenheck and K. Drexler and F. Mohammad and L. Siklosky and K. Walker and C. Arnold-Hunter and R. Head and J. Hermos and H. Behr and B. Kinne and D. Savage and J. Wickis and L. Rugle and O. Kausch and H. Zegarna and K. Conti and H. Adkins and G. Harris and C. Cartier and B. Adinoff and L. Burney and J. Fields and B. Hudson and J. Corder and A. Quintero and J. Grabowski and R. Wancha and Y. Ruiz and S. Chermack and S. Fleming and K. Gamel and B. Sullivan and L. Madlock and R. Murray and J. Williams and R. Lewandowski and T. Owens and M. FeBornstein and J. Pena and B. Cotton-Brown and M. Cowie and A. Connelly and W. Hill and A. Holmes and J. Fiery and P. Casadonte and S. Kushner and S. Johnson and J. Siegris and N. Lynch and E. Richardson and A. Butcher and S. Nixon and C. Shaw and R. Joswick and D. Bertoch and H. Engebretson and L. Haynes-Tucker and L. Moffet and J. Weintraub and R. Lutz and S. Clinton and F. Pohlman and R. Royal and S. Harris and I. Maany and J. DeStefano and M. Andem and C. Hackett and J. McNeely and S. Dyanick and D. Torpey and S. Poole and E. Moeller and A. Scheamania and G. Kaplan and H. MacAskill and P. Charnley and C. Williams and C. Stock and P. Stevenson and S. Plumb and M. Dean and J. Hunter and P. Banys and I. Rhew and S. Staccone and J. Kelly and S. Shives and A. Saxon and M. Willey-Allen and J. Williams and K. Lunna and V. Ruscigno and S. Brown and K. Shaffer and J. Collins and S. Kilby and T. Burke and L. Linzy and C. Dalzell and M. Rhoads and J. Kelly and N. Banks and J. Arflin and D. Briones and W. Krol and M. Miller and C. Messick",
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TY - JOUR

T1 - Naltrexone is associated with reduced drinking by alcohol dependent patients receiving antidepressants for mood and anxiety symptoms

T2 - Results from VA cooperative study no. 425, "naltrexone in the treatment of alcoholism"

AU - Krystal, John H.

AU - Gueorguieva, Ralitza

AU - Cramer, Joyce

AU - Collins, Joseph

AU - Rosenheck, Robert

AU - Drexler, K.

AU - Mohammad, F.

AU - Siklosky, L.

AU - Walker, K.

AU - Arnold-Hunter, C.

AU - Head, R.

AU - Hermos, J.

AU - Behr, H.

AU - Kinne, B.

AU - Savage, D.

AU - Wickis, J.

AU - Rugle, L.

AU - Kausch, O.

AU - Zegarna, H.

AU - Conti, K.

AU - Adkins, H.

AU - Harris, G.

AU - Cartier, C.

AU - Adinoff, B.

AU - Burney, L.

AU - Fields, J.

AU - Hudson, B.

AU - Corder, J.

AU - Quintero, A.

AU - Grabowski, J.

AU - Wancha, R.

AU - Ruiz, Y.

AU - Chermack, S.

AU - Fleming, S.

AU - Gamel, K.

AU - Sullivan, B.

AU - Madlock, L.

AU - Murray, R.

AU - Williams, J.

AU - Lewandowski, R.

AU - Owens, T.

AU - FeBornstein, M.

AU - Pena, J.

AU - Cotton-Brown, B.

AU - Cowie, M.

AU - Connelly, A.

AU - Hill, W.

AU - Holmes, A.

AU - Fiery, J.

AU - Casadonte, P.

AU - Kushner, S.

AU - Johnson, S.

AU - Siegris, J.

AU - Lynch, N.

AU - Richardson, E.

AU - Butcher, A.

AU - Nixon, S.

AU - Shaw, C.

AU - Joswick, R.

AU - Bertoch, D.

AU - Engebretson, H.

AU - Haynes-Tucker, L.

AU - Moffet, L.

AU - Weintraub, J.

AU - Lutz, R.

AU - Clinton, S.

AU - Pohlman, F.

AU - Royal, R.

AU - Harris, S.

AU - Maany, I.

AU - DeStefano, J.

AU - Andem, M.

AU - Hackett, C.

AU - McNeely, J.

AU - Dyanick, S.

AU - Torpey, D.

AU - Poole, S.

AU - Moeller, E.

AU - Scheamania, A.

AU - Kaplan, G.

AU - MacAskill, H.

AU - Charnley, P.

AU - Williams, C.

AU - Stock, C.

AU - Stevenson, P.

AU - Plumb, S.

AU - Dean, M.

AU - Hunter, J.

AU - Banys, P.

AU - Rhew, I.

AU - Staccone, S.

AU - Kelly, J.

AU - Shives, S.

AU - Saxon, A.

AU - Willey-Allen, M.

AU - Williams, J.

AU - Lunna, K.

AU - Ruscigno, V.

AU - Brown, S.

AU - Shaffer, K.

AU - Collins, J.

AU - Kilby, S.

AU - Burke, T.

AU - Linzy, L.

AU - Dalzell, C.

AU - Rhoads, M.

AU - Kelly, J.

AU - Banks, N.

AU - Arflin, J.

AU - Briones, D.

AU - Krol, W.

AU - Miller, M.

AU - Messick, C.

PY - 2008/1

Y1 - 2008/1

N2 - Background: It is not clear whether naltrexone is effective in reducing alcohol consumption among patients with clinically significant mood symptoms and whether naltrexone favorably interacts with antidepressant medications when they are co-prescribed. Methods: This study reflects a secondary analysis of the first 13 weeks of VA CSP #425, a study that evaluated the efficacy of naltrexone 50 mg/d in 627 alcohol dependent military veterans receiving Twelve Step Facilitation therapy at 20 VA Medical Centers. This study included patients with comorbid mood and anxiety disorders, providing they did not need treatment for these comorbid conditions at the time of study entry. Sixty patients developed sufficiently severe mood symptoms while on study medication that they required antidepressant treatment. This analysis evaluated whether the efficacy of naltrexone and placebo was influenced by the prescription of antidepressant medications to some study patients for their mood and anxiety symptoms. Results: In patients randomized to placebo (n = 209), prescription of antidepressants was associated with a significantly higher percentage of drinking days (lsmean = 24.4, se = 4.85 vs. lsmean = 12.9, se = 1.69, p = 0.02). Although the group of patients receiving naltrexone (n = 418) was larger than the group assigned to placebo, there were no significant differences in drinking-related outcomes in the groups who did or did not receive antidepressants (lsmean = 11.5, se = 1.18 vs. lsmean = 12.9, se = 1.69, p = 0.47). Among the group of patients receiving antidepressants, naltrexone prescription was associated with a reduction in the percent drinking days compared to placebo [lsmean = 10.1, se = 3.47 vs. lsmean = 24.4, se = 4.85, F(1,556) = 5.84, p = 0.02]. Conclusions: 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.

AB - Background: It is not clear whether naltrexone is effective in reducing alcohol consumption among patients with clinically significant mood symptoms and whether naltrexone favorably interacts with antidepressant medications when they are co-prescribed. Methods: This study reflects a secondary analysis of the first 13 weeks of VA CSP #425, a study that evaluated the efficacy of naltrexone 50 mg/d in 627 alcohol dependent military veterans receiving Twelve Step Facilitation therapy at 20 VA Medical Centers. This study included patients with comorbid mood and anxiety disorders, providing they did not need treatment for these comorbid conditions at the time of study entry. Sixty patients developed sufficiently severe mood symptoms while on study medication that they required antidepressant treatment. This analysis evaluated whether the efficacy of naltrexone and placebo was influenced by the prescription of antidepressant medications to some study patients for their mood and anxiety symptoms. Results: In patients randomized to placebo (n = 209), prescription of antidepressants was associated with a significantly higher percentage of drinking days (lsmean = 24.4, se = 4.85 vs. lsmean = 12.9, se = 1.69, p = 0.02). Although the group of patients receiving naltrexone (n = 418) was larger than the group assigned to placebo, there were no significant differences in drinking-related outcomes in the groups who did or did not receive antidepressants (lsmean = 11.5, se = 1.18 vs. lsmean = 12.9, se = 1.69, p = 0.47). Among the group of patients receiving antidepressants, naltrexone prescription was associated with a reduction in the percent drinking days compared to placebo [lsmean = 10.1, se = 3.47 vs. lsmean = 24.4, se = 4.85, F(1,556) = 5.84, p = 0.02]. Conclusions: 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.

KW - Alcohol Dependence

KW - Antidepressants

KW - Depression

KW - Mood Disorder

KW - Naltrexone

KW - Treatment

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UR - http://www.scopus.com/inward/citedby.url?scp=37349048929&partnerID=8YFLogxK

U2 - 10.1111/j.1530-0277.2007.00555.x

DO - 10.1111/j.1530-0277.2007.00555.x

M3 - Article

C2 - 18070245

AN - SCOPUS:37349048929

VL - 32

SP - 85

EP - 91

JO - Alcoholism: Clinical and Experimental Research

JF - Alcoholism: Clinical and Experimental Research

SN - 0145-6008

IS - 1

ER -