A number of studies conducted in the 1980s and the early 1990s showed that SSRIs (selective serotonin reuptake inhibitors) such as Prozac led to short term reductions in alcohol consumption in both humans and rats. This led to a lot of enthusiasm and intensive research on the effects of SSRIs on alcohol consumption because some researchers hoped that SSRIs might hold the key to the cure for alcoholism.
However, the research proved that the effects of SSRIs on alcohol consumption are far less simple than they initially appeared. The short term reductions in drinking in human alcoholics lasted no longer than a week and then the subjects were once again drinking just as much as they ever had. Moreover, the research showed that SSRIs may actually worsen drinking in Early Onset Alcohol Abusers and in women.
There is one group, however, which seems definitely to benefit from SSRIs. Patients who have both Alcohol Dependence and severe Major Depressive Disorder show significant improvement both in depression and alcohol consumption when treated with SSRIs. In this article we will take a look at the research which has been done on SSRIs and alcohol consumption in these populations.
In 1995 and 1996 Dr Henry Kranzler MD and his colleagues did a study which suggests that the SSRI Prozac may actually worsen the drinking behavior of Early Onset Alcohol Abusers while having no effect at all on Late Onset Alcohol Abusers. Early Onset Alcohol Abusers are defined as those who begin heavy drinking in early life and who have worse alcohol related consequences. Late Onset Alcohol Abusers are defined as those who begin heavy drinking later in life and have fewer alcohol related problems.
The Kranzler group studied the effects of Prozac on 95 non-depressed patients who were being treated with talk therapy for Alcohol Dependence. Half of these subjects received Prozac and the other half got a placebo. When Kranzler and his colleagues analyzed the group as a whole they found that there was no significant difference in improvement between the placebo group and the group receiving Prozac.
However, they then divided the patients up into two categories: Late Onset Alcohol Abusers and Early Onset Alcohol Abusers. When they reanalyzed the data using these two categories they obtained a very surprising result which was quite contrary to what they expected. They found that Early Onset Alcohol Abusers receiving the Prozac did significantly WORSE than the group receiving the placebo. There was no significant difference between the Late Onset Alcohol Abusers who received Prozac and those who received the placebo.
The Kranzler study strongly suggests that Prozac may actually worsen the drinking of Early Onset Alcohol Abusers who are not receiving any sort of talk therapy for their Alcohol Dependence. All that remains is for someone to do the crucial experiment needed to verify this highly likely conclusion.
In 1995 Dr Claudio Naranjo MD and his colleagues did a study of the effect of the SSRI Celexa on 62 non-depressed problem drinkers who were being taught moderate drinking strategies. 56% of the subjects in the study were male and 44% were female. Half of the subjects in the study got Celexa and the other half got a placebo. The Naranjo group found that women receiving the Celexa did significantly WORSE than women receiving the placebo in moderating their drinking. The men did the same whether they received Celexa or the placebo. This suggests that Celexa may actually INCREASE the drinking of female problem drinkers who are not receiving moderation training or some other form for talk therapy. All that is needed to confirm this is an experiment with drinkers who are receiving Celexa but no talk therapy.
The patients in the studies we have discussed so far did not suffer from severe Major Depressive Disorder. In 1997 Dr Jack Cornelius MD and his colleagues studied the effect of the SSRI Prozac on 51 patients with both severe Major Depressive Disorder and severe Alcohol Dependence. The subjects were 51% male and 49% female. All patients received talk therapy for their Alcohol Dependence. In addition to the talk therapy, 25 patients received Prozac and 26 received a placebo. In this study the patients who received the Prozac showed significantly greater improvements in both depression and in drinking outcomes than did those receiving the placebo. Taken together with the other studies this leads to the conclusion that SSRIs can lead to a reduction in drinking in people with severe Major Depressive Disorder but not in other groups.
In 2007 Dr Kathryn Graham PhD and her colleagues published the results of a massive telephone survey of 14,063 individuals in Canada which asked people about their use of alcohol and antidepressants. This survey showed that depressed men who took antidepressants drank less alcohol on the average than did depressed men who did not take antidepressants. However, depressed women who took antidepressants drank at least as much as did depressed women who did not take antidepressants, if not more.
Like the Naranjo study, this study also suggests that antidepressants affect the drinking behavior of men differently than they do the drinking behavior of women. Since this study did not specifically ask respondents if they were taking an SSRI or another type of antidepressant such as a tricyclic we must be somewhat cautious in what we can conclude from it. It is possible that if the data were limited to SSRIs that the researchers might have seen an increase in the alcohol consumption of women taking the medication. It remains for further research to confirm whether this is actually the case.
The studies to date seem to suggest that SSRIs only lead to reduced alcohol consumption in men who have severe Major Depressive Disorder. SSRIs do not seem to affect the alcohol consumption of most other people either one way or the other. However, the studies also suggest that it is possible that SSRIs might tend to increase alcohol consumption in some individuals--particularly in women and in Early Onset Alcohol Abusers.
Therefore, we would like to suggest that people become pro-active health care consumers. If you drink alcohol and take antidepressant and the antidepressants seem to be causing you to increase your drinking or to drink in a dangerous fashion, then you should talk to your doctor. You may need to switch to a different kind of antidepressant or stop taking antidepressants altogether. Or you may find that quitting drinking is your wisest course.
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Graham, K, Massak, A. (2007). Alcohol consumption and the use of antidepressants. CMAJ. 176(5), 633-7.
Kranzler HR, Burleson JA, Korner P, Del Boca FK, Bohn MJ, Brown J, Liebowitz
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Kranzler HR, Burleson JA, Brown J, Babor TF. (1996). Fluoxetine treatment seems to reduce the beneficial effects of cognitive-behavioral therapy in type B alcoholics. Alcoholism: Clinical and Experimental Research, 20, 1534-41.
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