The Use of Antidepressants in Alcohol-Dependent Veterans
J Clin Psychiatry 2003;64(8):865-870
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Although some research reports
suggest antidepressants may be an effective treatment for alcohol
dependence, their clinical use has been controversial.
Method: By using comprehensive national
administrative data from the Department of Veterans Affairs (VA)
documenting psychiatric diagnoses and care under natural
conditions in both mental health and non-mental health settings,
the use of antidepressants was compared in alcoholic and
non-alcoholic veterans. Data were collected from April 1, 2000,
to Sept. 30, 2000.
Results: Overall, patients with alcohol
dependence were significantly more likely to be prescribed
antidepressants than individuals without alcoholism (38.9% vs.
31.2%), but multivariate analysis showed that this was
attributable to the higher rate of comorbid psychiatric diagnoses
in this group. After controlling for diagnosis and other
potentially confounding factors, alcohol-dependent individuals
treated in specialty mental health clinics were in fact less
likely to be prescribed antidepressants (odds ratio = 0.95, p
< .0001). Of patients treated with antidepressants, those with
alcohol dependence were more likely to be prescribed newer
antidepressants (odds ratio = 1.22, p < .0001). Among patients
treated in non-mental health clinics, there were no significant
differences in rate of antidepressant use between
alcohol-dependent and non-alcohol-dependent individuals with
mental illness after controlling for other factors.
Conclusion: The principal finding is that a
diagnosis of alcoholism, independent of other factors, is
associated with a decreased likelihood of receiving
antidepressant treatment in VA mental health clinics, suggesting
that prescribers have not embraced reports of their efficacy in
alcohol dependence. In fact, this may reflect a disinclination to
use medications to treat alcoholism in specialty mental health
clinics but not in non-mental health clinics.