CCP Class of 2020
IPPE-L ( Winter 2018)
Question #9 What is the role of citalopram for the management of
patients 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 be
for social gathering, celebration and depression. The question is why do people
tend to consume more than they need? Alcohol is great for the body when it is
consumed with moderation. However, some people drink above the recommended need,
and that’s when many issues occur. Too much consumption of alcohol can lead to
chronic liver or kidney inflammation, because many drugs are metabolized by
those two organs in the body. In addition, alcohol can damage the brain causing
impaired memory, and slurred speech. Alcoholics often have the feelings that they
cannot function without consuming alcohol, however this could lead to tardiness
at work place, and mental impairment.
In today’s world, there are many therapeutic treatments
available to help alcoholism. Citalopram
has been an antidepressant is one of the main recommended medication. This
belongs to a drug known as SSRIs (Selective Serotonin Reuptake Inhibitors) with
few mechanisms concerning how citalopram works in the body. Citalopram blocks
the reuptake of serotonin at the serotonin reuptake pump of the neuronal
membrane, enhancing the actions of serotonin on 5HT1A auto receptors. It binds
with significantly less affinity to histamine, acetylcholine, and
norepinephrine receptors than tricyclic antidepressant drugs.
A double-blind, randomized, placebo-controlled
trial was studied to determine the outcomes of use of citalopram in the
treatment of alcohol abuse. The study included two hundred and sixty-five
patients that were diagnosed of alcohol abuse. The clinical trial excluded
participants that were using serotonergic medication and who have the presence
of polysubstance dependence. They were assigned to two groups: one
with placebo and the second group with citalopram 20 mg daily during their
first week, and 40 mg the following weeks from week 2 to week 12th.
Patients who were receiving the citalopram were also enrolled in a weekly
psychotherapy course. The program consisted of 90-minute group psychotherapy
and 50-minute individual session. The therapists are nurses,
psychologists, and therapists that have at least 5 years of history of alcohol
addiction who have been completely recovered. The individual 50-minute therapy
was about self-awareness, and self-motivation. It was used in helping them
achieve their goals, and also adopt to a positive responsibility to prevent
relapse in the future. At the end of the twelfth week, patients were reassessed
from the two groups to determine if there were any changes in their alcohol intake
that was affected by their depression status.
The primary objective of the study was to
determine how efficient the citalopram 20 mg and 40 mg in the treatment of
alcohol abuse compared to placebo. The second objective was to determine how each
participant can be with the 50-minute individual session therapist to promote
personal responsibility, strategies to educate themselves to avoid relapse, and
also to elevate motivation level of each individual. To make this treatment
possible, the participants were categorized into complete, partial, and
non-response categories after the first 12 weeks. To determine the percentage
of responders, the calculation was based on a composite of percentage change in
number of drinking days and percentage change in the mean of drinks per days
for another 30 days treatment. There were 50 to 100% reduction in the complete
response, and there is no response reduction in those groups.
To compare the results, T-test and Chi-square
test were used for continuous variables. For categorical variables, the use of
citalopram and placebo groups test were compared. After the 12 weeks of
the trial, 42% of the participants discontinued and 5% were withdrawn for
medication adverse reaction symptoms.
The overall result revealed 31% of the
participants had suicidal thoughts during the therapy and 18% had made at least
suicide attempt. The participants were married, and later were divorced. P
value was 0.039 for those who took citalopram, and 0.003 for those who were on
placebo. Overall the authors concluded the trial did not support the primary
hypothesis made that citalopram would be used as a treatment of alcohol
dependence. There is no known what type of external validity, demographic or
gender were the participants. The result might be different in other
population. Therefore, we can’t just base on this trial to conclude that
citalopram is not effective in the treatment of alcoholism.
double-blind placebo controlled study was done. According to an article
published by the university of Kuopio in Finland a controlled study in which
its aim was to know whether severe alcoholism is major concern in the society.
Should it be treated as a mentally unstable condition? Treatment of alcoholism
in this scientific study clearly indicated that patients that were placed on
citalopram were treated effectively than the patients that were placed on
placebo trial. In this study, 62 patients that were introduce didn’t have any
severe conditions such bipolar or any mental challenges, however the goal was
to find out whether citalopram being antidepressant could resolve the problem.
Citalopram is a re uptake inhibitor that is effective when alcoholism is caught
up in the early stage. This trial was carried out in a rehabilitation center in
the eastern part of Finland. The participants were males from age 20 to 60
years with no prior use of serotonin uptake inhibitors or any antidepressant
medications, no history of suicidal thoughts. The first week of the trial, the
participants 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 also
received psychotherapy and information about the drug regarding its adverse
reactions and side effects. The participants on placebo took one capsule the
first week and two capsules later. After at least one week of trial, some
participants dropped out with a p value of p<0.05 and a p value of 0.10 for those who were taking citalopram. The results showed that there was no difference in the patients that have alcohol dependence in the early set compared to those with late onset. In the second trial, citalopram seems to be the remedy, based on the fact that out of the 62 patients that were involved,31 patients got better. Also, the author really did a good job by disguising himself very carefully not disclosing his experiment. His grouping of the patients into two trials made it obvious that citalopram was effective. However, the trial was performed on males between the ages of 20 to 60. To conclude, I still emphasize that the author didn't include any external validity, this is because the trials were done in Eastern Europe. In addition, the author chose one specific demographic for the experiment to be carried out. The authors should have included females to trial, so they could justify their result on the contrary that citalopram is the more effective medication in treating alcoholism.