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Treatment of Late-Life Depression Complicated by Alcohol Dependence

Received December 10, 2003; revised March 25, April 28, 2004; accepted April 30, 2004. From the Section on Geriatric Psychiatry and the Center for the Study of Addictions and the Dept. of Psychiatry, Univ. of Pennsylvania, Philadelphia, PA, and the VISN 4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center. Send correspondence and reprint requests to David Oslin, M.D., Univ. of Pennsylvania, 3535 Market St., Room 3002, Philadelphia, PA 19104. e-mail: oslin{at}mail.med.upenn.edu
© 2005 American Association for Geriatric Psychiatry

Objectives: Among elderly patients, mental and physical illness are often present along with alcohol dependence. The interaction between alcohol use and concurrent physical or mental disabilities is complex and complicates treatment planning. The aim of this study was to test the efficacy of naltrexone combined with sertraline for the treatment of older adults with major depression and alcohol dependence. Methods: The sample was 74 subjects, age 55 and older, who met criteria for a depressive disorder along with alcohol dependence. All subjects were randomly assigned to 12 weeks of naltrexone 50 mg/day or placebo. Also, all subjects received sertraline 100 mg/day and individual weekly psychosocial support. Treatment response for alcohol consumption and depression was measured during the 12 weeks of treatment. Results: At baseline, the average age of subjects was 63.4, and subjects were drinking an average of 10.7 drinks per drinking day. The overall results are encouraging; 42% of the subjects had a remission of their depression and had no drinking relapses during the trial. There was no evidence for an added benefit of naltrexone in combination with sertraline, but there was significant correlation between any alcohol relapse during the trial and poor response to depression treatment. Conclusion: Patients with concurrent mental disorders, such as major depression and alcohol dependence, are increasingly prevalent in clinical practice and have been demonstrated to show poorer treatment response and higher treatment costs. The results of this trial underscore the importance of addressing alcohol use in the context of treating late-life depression.

Key Words: Depression • Alcoholism

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