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A 16-week, randomized study was performed to test the efficacy of two selective serotonin reuptake inhibitors (SSRIs) fluvoxamine and citalopram, in decreasing relapse and craving in alcoholics, and to investigate possible differences in their clinical profile. After detoxification, each of the 81 patients (55 males and 26 females) was randomly assigned to one of three groups: 23 subjects did not receive any pharmacological treatment, 25 were treated with fluvoxamine, 150mg/day, and 33 with citalopram, 20 mg/day. All patients received standard cognitive-behavioural therapy. Craving was assessed twice a month using a 10-step scale. Every intake of alcohol was considered a relapse and the subject was taken out of the study. At the end of the study, both the fluvoxamine and citalopram groups showed a statistically higher rate of continuous abstinence (63.6 and 60.7%, respectively) compared to the group without pharmacological treatment (30.4%). Relapse severity did not differ among the three groups. Only citalopram showed a significant effect on craving throughout the study period. This study confirmed the efficacy of SSRIs as an adjunct to psychotherapy to prevent relapse in alcoholics. The relationship between the effects of these SSRIs on abstinence and craving, as well as the differences between their profiles, are discussed.

The efficacy of fluvoxamine was compared to that of amitriptyline in a double-blind 6-week fixed-dose trial of 56 inpatients with major depressive episode. The two drugs were comparable in their antidepressant efficacy. We tested the percentage of improvement in Hamilton-D scores during the first and the second weeks of treatment as predictors of efficacy for the last week. Improvement rates during the second week significantly predicted the outcome. We also investigated whether or not some symptomatological characteristics would permit prior prediction of the outcome with amitriptyline or fluvoxamine, dividing our sample into responders and nonresponders to the two drugs. The four groups showed differences in their symptomatological profiles.

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