Fluoxetine Treatment Seems to Reduce the Beneficial Effects of Cognitive‐Behavioral Therapy in Type B Alcoholics

Kranzler, Henry R.; Burleson, Joseph A.; Brown, Joseph; Babor, Thomas F.

doi:10.1111/j.1530-0277.1996.tb01696.x

Cited by 195 publications

(124 citation statements)

References 45 publications

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“…Remarkably, the literature has demonstrated quite the opposite. For instance, Kranzler et al [182] observed that fluoxetine treatment appeared to worsen the clinical benefit of the adjunctive cognitive behavioral treatment and there was no difference from placebo. Actually, Type A-like or late-onset alcoholics, with presumably more normative 5-HT function, have been observed to experience improved drinking outcomes from sertraline both during active treatment [183] and at 6-month follow-up [184].…”

Section: Serotonin Reuptake Inhibitorsmentioning

confidence: 99%

Update on neuropharmacological treatments for alcoholism: Scientific basis and clinical findings

Johnson

2008

Biochemical Pharmacology

247

185

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The past decade has seen an expansion of research and knowledge on pharmacotherapy for the treatment of alcohol dependence. The Food and Drug Administration (FDA)-approved medications naltrexone and acamprosate have shown mixed results in clinical trials. Oral naltrexone and naltrexone depot formulations have generally demonstrated efficacy at treating alcohol dependence, but their treatment effect size is small, and more research is needed to compare the effects of different doses on drinking outcome. Acamprosate has demonstrated efficacy for treating alcohol dependence in European trials, but with a small effect size. In U.S. trials, acamprosate has not proved to be efficacious. Research continues to explore which types of alcohol-dependent individual would benefit the most from treatment with naltrexone or acamprosate. The combination of the two medications demonstrated efficacy for treating alcohol dependence in one European study but not in a multi-site U.S. study. Another FDA-approved medication, disulfiram, is an aversive agent that does not diminish craving for alcohol. Disulfiram is most effective when given to those who are highly compliant or who are receiving their medication under supervision. Of the non-approved medications, topiramate is among the most promising, with a medium effect size in clinical trials. Another promising medication, baclofen, has shown efficacy in small trials. Serotonergic agents such as selective serotonin reuptake inhibitors and the serotonin-3 receptor antagonist, ondansetron, appear to be efficacious only among certain genetic subtypes of alcoholic. As neuroscientific research progresses, other promising medications, as well as medication combinations, for treating alcohol dependence continue to be explored.

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Section: Serotonin Reuptake Inhibitorsmentioning

confidence: 99%

Update on neuropharmacological treatments for alcoholism: Scientific basis and clinical findings

Johnson

2008

Biochemical Pharmacology

247

185

View full text Add to dashboard Cite

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“…In fact, only one study of alcoholdependent individuals showed beneficial effects of an SSRI, and that effect was restricted to non-depressed alcoholics (Pettinati et al, 2001) or a subgroup classified as Type A alcoholics (Pettinati et al, 2000). In Type B alcoholics (Dundon et al, 2004;Kranzler et al, 1996) or Type II alcoholics (Chick et al, 2004), SSRIs may increase drinking relative to placebo treatment. In humans, low 5-HT turnover has been associated with increased alcohol-seeking behavior, alcoholism (Virkkunen and Linnoila, 1997), and impulsive violence (Virkkunen et al, 1995).…”

Section: Introductionmentioning

confidence: 99%

Can serotonin transporter genotype predict serotonergic function, chronicity, and severity of drinking?

Johnson

Javors

Roache

et al. 2008

Progress in Neuro-Psychopharmacology and Biological Psychiatry

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Serotonin transporter (5-HTT) activity is greater in carriers of the long (L) vs. short (S) alleles of the 5-HTT-linked polymorphic region (5′-HTTLPR) among healthy control subjects but not alcoholdependent adults. In 198 alcoholics, we determined the relationship between current or lifetime drinking and platelet 5-HTT function and density among allelic variants of the 5′-HTTLPR. SS subjects were younger than L-carriers (LL and LS) (p < 0.0085) and had fewer years of lifetime drinking. For L-carriers, the mean of B max for paroxetine binding, but not V max for serotonin (5-HT) uptake, was lower than that for SS subjects (p < 0.05). More L-carriers than their SS counterparts had V max for 5-HT uptake below 200 nmol/10 7 platelets-min (p < 0.05) and B max for paroxetine binding below 600 nmol/mg protein (p < 0.06). Current drinking (drinks per day during the past 14 days) correlated positively with K m and V max of platelet 5-HT uptake (p < 0.05) and negatively with B max , but not K d , of paroxetine binding (p < 0.05) for L-carriers alone. Years of lifetime drinking correlated negatively with K m and V max of platelet 5-HT uptake (p < 0.05) and B max , but not K d , of paroxetine binding (p < 0.05) for L-carriers alone. Among L-carriers alone, there were higher levels of platelet 5-HT uptake and lower levels of platelet paroxetine binding with increased drinking, and more lifetime drinking was associated with modestly lower levels of 5-HT uptake and paroxetine binding. Thus, 5-HTT expression varies with current and lifetime drinking in L-carriers alone.

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“…It was, however, too simplistic to think that Type 2 patients' drinking would therefore become less risky if the patient was prescribed an SSRI. In fact, it seems that Type 2 patients may have a less favourable outcome with SSRIs than placebo (Kranzler et al 1996;Chick et al 2002), or show no response while Type 1 patients benefit (Pettinati et al 2000). And, of course, while higher CSF 5HIAA in these Gerard's studies correlated with increased reproductive fitness, SSRIs in humans are notable for their inhibition of sexual performance.…”

Section: Simplistic Extrapolationsmentioning

confidence: 93%

Evolution And Addiction

Nesse

2002

Addiction

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Fluoxetine Treatment Seems to Reduce the Beneficial Effects of Cognitive‐Behavioral Therapy in Type B Alcoholics

Cited by 195 publications

References 45 publications

Update on neuropharmacological treatments for alcoholism: Scientific basis and clinical findings

Update on neuropharmacological treatments for alcoholism: Scientific basis and clinical findings

Can serotonin transporter genotype predict serotonergic function, chronicity, and severity of drinking?

Evolution And Addiction

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