The use of antidepressants in alcohol-dependent veterans

Background: Although some research reports suggest antidepressants may be an effective treatment for alcohol dependence, their clinical use has been controversial. Method: By using comprehensive national administrative data from the Department of Veterans Affairs (VA) documenting psychiatric diagnoses and care under natural conditions in both mental health and non-mental health settings, the use of antidepressants was compared in alcoholic and non-alcoholic veterans. Data were collected from April 1, 2000, to Sept. 30, 2000. Results: Overall, patients with alcohol dependence were significantly more likely to be prescribed antidepressants than individuals without alcoholism (38.9% vs. 31.2%), but multivariate analysis showed that this was attributable to the higher rate of comorbid psychiatric diagnoses in this group. After controlling for diagnosis and other potentially confounding factors, alcohol-dependent individuals treated in specialty mental health clinics were in fact less likely to be prescribed antidepressants (odds ratio = 0.95, p < .0001). Of patients treated with antidepressants, those with alcohol dependence were more likely to be prescribed newer antidepressants (odds ratio = 1.22, p < .0001). Among patients treated in non-mental health clinics, there were no significant differences in rate of antidepressant use between alcohol-dependent and non-alcohol-dependent individuals with mental illness after controlling for other factors. Conclusion: The principal finding is that a diagnosis of alcoholism, independent of other factors, is associated with a decreased likelihood of receiving antidepressant treatment in VA mental health clinics, suggesting that prescribers have not embraced reports of their efficacy in alcohol dependence. In fact, this may reflect a disinclination to use medications to treat alcoholism in specialty mental health clinics but not in non-mental health clinics.