Treatment Evaluation of Alcohol and Mood

The combination of alcohol dependence and depression is very common in people presenting to alcohol and drug services. Pharmacotherapy offers a significant step forward in treatment. Effective antidepressant medications have been available for a number of decades, but medications which assist with relapse prevention in alcohol dependence (antidipsotropics), other than the long-established disulfiram, have only been developed more recently. There have been no published randomised controlled trials investigating the combination of these medications in people with both problems. This study will investigate the effectiveness of 12 weeks treatment of citalopram (an antidepressant) compared with placebo in a group of patients presenting to one of five alcohol and drug treatment clinics in New Zealand, who are all being treated over the same time period with naltrexone (an antidipsotropic) and clinical case management. They will all have both alcohol dependence and major depression. All participants will receive standard clinical case management, which will cover the initial 12 weeks of combined pharmacotherapy, followed by a further 12 weeks of active monitoring and support. This study will make an important contribution to evaluating the place of antidepressants in clinical practice for patients with co-occurring alcohol dependence and depression.