Original ContributionsA Randomized Trial of Combined Citalopram and Naltrexone for Nonabstinent Outpatients With Co-Occurring Alcohol Dependence and Major DepressionAdamson, Simon J. PhD*; Sellman, J. Douglas PhD*; Foulds, James A. MB ChB*; Frampton, Christopher M.A. PhD*; Deering, Daryle PhD*; Dunn, Alistair FAChAM†; Berks, John FRANZCP‡; Nixon, Lee PhD§; Cape, Gavin FRANZCP∥ Author Information From the *Department of Psychological Medicine, University of Otago, Christchurch; †Community Mental Health & Addictions, Northland District Health Board, Northland; ‡Community Alcohol and Drug Service, Waitemata District Health Board, Auckland; §Community Alcohol and Drug Service, Nelson-Marlborough District Health Board, Nelson; and ∥Community Alcohol and Drug Service, Southern District Health Board, Dunedin, New Zealand. Received March 23, 2014; accepted after revision December 29, 2014. Reprints: Simon J. Adamson, PhD, Department of Psychological Medicine, University of Otago, Christchurch, 4 Oxford Terrace, Christchurch 8011, New Zealand (e-mail: [email protected]). Lee Nixon was previously affiliated with the Community Alcohol and Drug Service, Nelson-Marlborough District Health Board, Nelson, New Zealand. This study was funded by the Health Research Council of New Zealand grant HRC 07/138. Journal of Clinical Psychopharmacology: April 2015 - Volume 35 - Issue 2 - p 143-149 doi: 10.1097/JCP.0000000000000287 Buy Metrics Abstract Despite the high rate of co-occurrence of major depression and alcohol dependence, the role of pharmacotherapy in their treatment remains unclear. In the new era of naltrexone for alcohol dependence, it is notable that only 1 study to date has examined the efficacy of antidepressant medication prescribed concurrently with naltrexone. We aimed to determine whether combining naltrexone with citalopram produced better treatment outcomes than naltrexone alone in patients with co-occurring alcohol dependence and depression, and to investigate whether either sex or depression type (independent or substance-induced depression) moderated treatment response. Participants were 138 depressed alcohol-dependent adults who were not required to be abstinent at the commencement of the trial. They were randomized to 12 weeks of citalopram or placebo, plus naltrexone and clinical case management. Treatment was well attended, and medications were reasonably well tolerated with high adherence rates. Substantial improvements in both mood and drinking occurred in both groups, with no significant differences between groups on any of the mood or drinking outcome measures, whether or not other variables were controlled for. No interaction effect was found for independent/substance-induced depression status, whereas there was a marginal effect found by sex, with greater improvement in 1 drinking outcome measure (percent days abstinent) in women taking citalopram. These findings suggest that citalopram is not a clinically useful addition to naltrexone and clinical case management in this treatment population. Independent/substance-induced depression status did not predict treatment response. Findings for sex were equivocal. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.