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Comments and Controversies


Comorbid MDD and AUDs

Vol. 12, No. 04 / April 2013

In “Pharmacotherapy for comorbid depression and alcohol dependence” (Current Psychiatry, January 2013, p. 24-32; bit.ly/1dBavVI), Drs. Gianoli and Petrakis report that the potential benefits of mixing antidepressants and alcohol dependence medications is extremely limited. Their article confirms the general wisdom in addiction psychiatry and is distressing in the short shrift given to the primary avenue physicians have for treating this dual condition—encouraging abstinence.

McLellan et al1 found that treating alcohol addiction produces outcomes comparable to treating hypertension and diabetes. However, if psychiatry were to bring its current overemphasis on pharmacology and underappreciation of psychotherapy to treating alcohol addiction, it would not produce the effectiveness of current multimodal, multidisciplinary approaches. Under the Affordable Care Act, primary care physicians will be expected to identify high-risk alcohol consumption and encourage reduction of risk, including treatment and recovery. What the authors allude to as “encouraging abstinence” is a complex art and craft that all physicians will need to attend to more than in the past. Drs. Gianoli and Petrakis’ work tells us why this is so: pharmacology does not rule in the treatment of mixed depression and alcohol dependence.

Timmen L. Cermak, MD
Immediate Past President
California Society of Addiction Medicine
Mill Valley, CA

The authors respond

We thank Dr. Cermak for his comments on our article. We wrote a review of the literature on the efficacy of various pharmacologic treatments to treat patients with comorbid depression and alcohol dependence. The purpose of our review was to remind practitioners that efficacy of antidepressants or medications to treat alcohol use disorders may be different in individuals with a comorbid disorder. Studies determining efficacy have been conducted primarily in noncomorbid groups and the results may not be generalizable. Emerging literature is trying to address this shortcoming. This is an important point that we hope we adequately conveyed to Current Psychiatry’s readers.

Our article was not a comprehensive review of all possible treatment options; we mentioned that a review of nonpharmacologic treatments was beyond the scope of our review. This does not mean that psychosocial treatments are not valued or important; they are an important part of any comprehensive treatment plan.

Mayumi Okada Gianoli, PhD
Postdoctoral Fellow
Department of Psychiatry
Yale University School of Medicine

Ismene L. Petrakis, MD
Professor of Psychiatry
Yale University School of Medicine
Chief of Psychiatry Service
Veterans Affairs Connecticut Healthcare Systems
New Haven, CT

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