Treating alcohol dependence and anxiety or depression

1
Treating alcohol dependence and anxiety or
depression

• SIGN guideline
• The management of harmful drinking and alcohol
  dependence

2
SIGN Guideline

• Key question 20
• What evidence is there regarding the
  effectiveness of antidepressants in relieving
  depression /or preventing relapse?
• 25/10/01

3
Levels of evidence

• 1 Well conducted meta-analyses, systematic
  reviews of random controlled trials or random
  controlled with a low risk of bias

4
Anxiety Depression

• Good evidence that most anxiety depression
  resolves with standard treatment of the alcohol
  dependence.
• 
  

5

• 80 anxiety symptoms resolve at 12 weeks
  abstinence
• Anxiety depression rating scales reflected
  those in the general population at 6 weeks
  abstinence

6
Panic disorders/social phobia

• No consistent evidence of extra benefit of CBT
  beyond simultaneous treatment for the alcohol
  problem.
• 
  

7

• B Patients with an alcohol problem and anxiety or
  depression should be treated for the alcohol
  problem first.

8
Depressive illness in detoxified patients

• Antidepressants improve depressive symptoms.
• In some studies there were improved drinking
  outcomes.
• Strongest effect in Fluoxetine.

9

• B If depressive symptoms persist for
• gt 2 weeks following treatment for alcohol
  dependence, consideration should be given to
  using an SSRI or referring for counselling or
  specialist psychological treatment along with the
  relapse prevention treatment.

10
SSRIs

• There may be a gender difference in response to
  SSRIs
• A subset of patients with early onset, positive
  family history poor impulse control may have
  worse outcomes when treated with SSRIs.

11
Anxiety symptoms

• Anxiety symptoms respond to SSRIs in non alcohol
  dependent patients.

12

• D If severe anxiety symptoms persist for gt 2
  weeks in abstinent patients, consideration should
  be given to using an SSRI, or referring for
  specialist psychological treatment along with the
  relapse prevention treatment.