Patients with an AUD often have co-occurring psychiatric disorders,5 though psychiatric symptoms (e.g., depressed mood) often diminish or resolve with a reduction in heavy alcohol use or abstinence from alcohol.,41 Persistent symptoms even with abstinence may require pharmacological treatment. When psychiatric symptoms persist despite a substantial reduction or cessation in drinking, the optimal approach is to continue the alcohol pharmacotherapy and add a specific psychiatric medication. One example that illustrates the potential utility of combining medications to treat a co-occurring AUD and psychiatric disorder is a study that randomly assigned 170 depressed patients with AUD to treatment with sertraline (200 mg/day [N=40]), naltrexone (100 mg/day [N=49]), sertraline plus naltrexone (N=42), or double placebo (N=39) for 14 weeks. The combined treatment group had a significantly higher abstinence rate (53.7%) and longer time before relapsing to heavy alcohol use (median=98 days) than the other three groups (naltrexone: 21.3% and 29 days, respectively; sertraline: 27.5% and 23 days, respectively; and placebo: 23.1% and 26 days, respectively). The naltrexone-only, sertraline-only, and placebo groups did not differ from one another.42 In combining medications, the potential for drug-drug interactions should be considered.43
