Emeline Gbegan CCP Class of 2020IPPE-L ( Winter 2018) Question #9 What is the role of citalopram for the management ofpatients with alcoholism? Whenever an alcohol is mentioned, many thoughts ring in my mind.There are so many reasons to why people consumed this commodity. This could befor social gathering, celebration and depression. The question is why do peopletend to consume more than they need? Alcohol is great for the body when it isconsumed with moderation. However, some people drink above the recommended need,and that’s when many issues occur.
Too much consumption of alcohol can lead tochronic liver or kidney inflammation, because many drugs are metabolized bythose two organs in the body. In addition, alcohol can damage the brain causingimpaired memory, and slurred speech. Alcoholics often have the feelings that theycannot function without consuming alcohol, however this could lead to tardinessat work place, and mental impairment.In today’s world, there are many therapeutic treatmentsavailable to help alcoholism. Citalopramhas been an antidepressant is one of the main recommended medication. Thisbelongs to a drug known as SSRIs (Selective Serotonin Reuptake Inhibitors) withfew mechanisms concerning how citalopram works in the body. Citalopram blocksthe reuptake of serotonin at the serotonin reuptake pump of the neuronalmembrane, enhancing the actions of serotonin on 5HT1A auto receptors. It bindswith significantly less affinity to histamine, acetylcholine, andnorepinephrine receptors than tricyclic antidepressant drugs.
A double-blind, randomized, placebo-controlledtrial was studied to determine the outcomes of use of citalopram in thetreatment of alcohol abuse. The study included two hundred and sixty-fivepatients that were diagnosed of alcohol abuse. The clinical trial excludedparticipants that were using serotonergic medication and who have the presenceof polysubstance dependence. They were assigned to two groups: onewith placebo and the second group with citalopram 20 mg daily during theirfirst week, and 40 mg the following weeks from week 2 to week 12th.Patients who were receiving the citalopram were also enrolled in a weeklypsychotherapy course. The program consisted of 90-minute group psychotherapyand 50-minute individual session.
The therapists are nurses,psychologists, and therapists that have at least 5 years of history of alcoholaddiction who have been completely recovered. The individual 50-minute therapywas about self-awareness, and self-motivation. It was used in helping themachieve their goals, and also adopt to a positive responsibility to preventrelapse in the future. At the end of the twelfth week, patients were reassessedfrom the two groups to determine if there were any changes in their alcohol intakethat was affected by their depression status. The primary objective of the study was todetermine how efficient the citalopram 20 mg and 40 mg in the treatment ofalcohol abuse compared to placebo. The second objective was to determine how eachparticipant can be with the 50-minute individual session therapist to promotepersonal responsibility, strategies to educate themselves to avoid relapse, andalso to elevate motivation level of each individual. To make this treatmentpossible, the participants were categorized into complete, partial, andnon-response categories after the first 12 weeks. To determine the percentageof responders, the calculation was based on a composite of percentage change innumber of drinking days and percentage change in the mean of drinks per daysfor another 30 days treatment.
There were 50 to 100% reduction in the completeresponse, and there is no response reduction in those groups. To compare the results, T-test and Chi-squaretest were used for continuous variables. For categorical variables, the use ofcitalopram and placebo groups test were compared. After the 12 weeks ofthe trial, 42% of the participants discontinued and 5% were withdrawn formedication adverse reaction symptoms. The overall result revealed 31% of theparticipants had suicidal thoughts during the therapy and 18% had made at leastsuicide attempt.
The participants were married, and later were divorced. Pvalue was 0.039 for those who took citalopram, and 0.003 for those who were onplacebo. Overall the authors concluded the trial did not support the primaryhypothesis made that citalopram would be used as a treatment of alcoholdependence. There is no known what type of external validity, demographic orgender were the participants. The result might be different in otherpopulation.
Therefore, we can’t just base on this trial to conclude thatcitalopram is not effective in the treatment of alcoholism.Anotherdouble-blind placebo controlled study was done. According to an articlepublished by the university of Kuopio in Finland a controlled study in whichits aim was to know whether severe alcoholism is major concern in the society.Should it be treated as a mentally unstable condition? Treatment of alcoholismin this scientific study clearly indicated that patients that were placed oncitalopram were treated effectively than the patients that were placed onplacebo trial. In this study, 62 patients that were introduce didn’t have anysevere conditions such bipolar or any mental challenges, however the goal wasto find out whether citalopram being antidepressant could resolve the problem.Citalopram is a re uptake inhibitor that is effective when alcoholism is caughtup in the early stage. This trial was carried out in a rehabilitation center inthe eastern part of Finland. The participants were males from age 20 to 60years with no prior use of serotonin uptake inhibitors or any antidepressantmedications, no history of suicidal thoughts.
The first week of the trial, theparticipants on citalopram were receiving 20 mg of citalopram in the morning.After the first week, they increased the dose to 40 mg/day. They were alsoreceived psychotherapy and information about the drug regarding its adversereactions and side effects. The participants on placebo took one capsule thefirst week and two capsules later. After at least one week of trial, someparticipants dropped out with a p value of p<0.05 and a p value of 0.10 forthose who were taking citalopram. The results showed that there was nodifference in the patients that have alcohol dependence in the early setcompared to those with late onset.
Inthe second trial, citalopram seems to be the remedy, based on the fact that outof the 62 patients that were involved,31 patients got better. Also, the authorreally did a good job by disguising himself very carefully not disclosing hisexperiment. His grouping of the patients into two trials made it obvious thatcitalopram was effective. However, the trial was performed on males between theages of 20 to 60. To conclude, I stillemphasize that the author didn’t include any external validity, this is becausethe trials were done in Eastern Europe.
Inaddition, the author chose one specific demographic for the experiment to be carriedout. The authors should have included females to trial, so they could justifytheir result on the contrary that citalopram is the more effective medicationin treating alcoholism.