A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the treatment of alcohol dependence. Naltrexone and Disulfiram in Patients with Alcohol Dependence and Comorbid Psychiatric Disorders Psychotic spectrum disorders and alcohol abuse: a review of pharmacotherapeutic strategies and a report on the effectiveness of naltrexone and disulfiram. Naltrexone and Disulfiram in Patients with Alcohol Dependence and Comorbid Post-Traumatic Stress Disorder Prescription procedures in medication for relapse prevention after inpatient treatment for alcohol use disorders in Switzerland. Effects of disulfiram on the sleep of chronic alcoholics. Naltrexone augmentation of neuroleptic treatment in alcohol abusing patients with schizophrenia A change of paradigm in the treatment of low-severity alcohol-dependent patients. Sleep disturbance in alcoholism: proposal of a simple measurement, and results from a 24-week randomized controlled study of alcohol-dependent patients assessing acamprosate efficacy. Switching outpatients with bipolar or schizoaffective disorders and substance abuse from their current antipsychotic to aripiprazole. Naltrexone increases the latency to drink alcohol in social drinkers. Naltrexone decreases craving and alcohol self-administration in alcohol-dependent subjects and activates the hypothalamo–pituitary–adrenocortical axis An open randomized trial comparing disulfiram and topiramate in the treatment of alcohol dependence. A double-blind, placebo-controlled trial combining sertraline and naltrexone for treating co-occurring depression and alcohol dependence. Naltrexone treatment of adolescent alcoholics: an open-label pilot study. Treatment of alcohol dependence in patients with co-morbid major depressive disorder – predictors for the outcomes with memantine and escitalopram medication Effect of naltrexone and ondansetron on alcohol cue-induced activation of the ventral striatum in alcohol-dependent people.
AIM To compare the effects in alcohol-dependent patients of three pharmacotherapies , disulfiram ( DIS ) , naltrexone ( NTX ) , and acamprosate ( ACA ) , when used with a brief manual-based cognitive-behavioural intervention . METHOD We conducted a r and omized , open label , multicentre naturalistic study in two phases ; first , a 12-week continuously supervised medication , followed by targeted medication ( TM ) up to 52 weeks in addition to a 67-week follow-up period ; altogether 119 weeks ( 2.5 years ) , in 243 voluntary treatment-seeking alcohol-dependent adult out patients . Subjects were r and omized 1:1:1 to receive supervised NTX , ACA or DIS , 50 , 1998 , or 200 mg , respectively , per day , plus a brief manual-based cognitive-behavioural intervention . The patients were met in the second and sixth weeks , and then after 3 , 6 , and 12 months . The primary outcome measures were the time ( days ) to first heavy drinking day ( HDD ) , and time during the first 3 months to the first drinking day after medication started . Secondary variables were abstinent days/week ( 0 drinks/day ) , average weekly alcohol intake , Alcohol Use Disorder Identification Test ( AUDIT ) , Severity of Alcohol Dependence Data ( SADD ) , and quality of life ( QL ) measures . RESULTS All three study groups showed marked reduction in drinking , from baseline to the end of the study . During the continuous medication phase , treatment with DIS was more effective in reducing HDDs and average weekly alcohol consumption , and increasing time to the first drink , as well as the number of abstinent days . During the TM period , there were no significant differences between the groups in time to first HDD and days to first drinking , but the abstinence days were significantly more frequent in the DIS group than ACA and NTX . There were no differences between the NTX and ACA groups in either phase of the study of drinking outcomes . However , SADD scores improved more in the NTX group than the ACA group . CONCLUSIONS Patients allocated to ACA , NTX and DIS combined with brief manual-based cognitive behavioural intervention significantly reduce their alcohol consumption and report improved QL . Supervised DIS appeared superior , especially during the continuous medication period , to NTX and ACA BACKGROUND Disulfiram and naltrexone are approved by the Food and Drug Administration ( FDA ) for the treatment of alcoholism , but these agents have not been rigorously evaluated in dually diagnosed individuals . METHOD Two-hundred and fifty-four patients with an Axis I psychiatric disorder and comorbid alcohol dependence were treated for 12 weeks in an outpatient medication study conducted at three Veterans Administration outpatient clinics . R and omization included assignment to one of four groups : 1 ) naltrexone alone ; 2 ) placebo alone ; 3 ) ( open-label ) disulfiram and ( blinded ) naltrexone ; or 4 ) ( open-label ) disulfiram and ( blinded ) placebo . Medication compliance was evaluated using the Microelectric Events Monitoring System . Primary outcomes were measures of alcohol use . Secondary outcomes included psychiatric symptoms , alcohol craving , g-GGT levels and adverse events . RESULTS There was a high rate of abstinence across groups . Subjects treated with an active medication had significantly more consecutive weeks of abstinence and less craving than those treated with placebo , but there were no significant group differences in other measures of alcohol consumption . There was no advantage of the combination of both medications . CONCLUSIONS These data suggest a modest advantage for the use of disulfiram and naltrexone for this group of dually diagnosed alcohol-dependent individuals but did not suggest an advantage in the combination The rate of substance-use disorders in patients with mental illnesses within the psychotic spectrum , such as schizophrenia , schizoaffective disorder , and bipolar disorder , is higher than the rate observed in the general population and is associated with significant morbidity and mortality . Although there are currently 3 medications approved by the Food and Drug Administration for the treatment of alcohol dependence , no medications have been approved for the specific treatment of dually diagnosed patients . A small but growing body of literature supports the use of 2 of these medications , disulfiram and naltrexone , in dually diagnosed individuals . This article outlines a review of the literature about the use of disulfiram and naltrexone for alcoholism and in patients with comorbid mental illness . In addition , results are presented of a 12-week r and omized clinical trial of disulfiram and naltrexone alone and in combination for individuals with Axis I disorders and alcohol dependence who were also receiving intensive psychosocial treatment . Individuals with a psychotic spectrum disorder , including schizophrenia , schizoaffective disorder , and bipolar disorder , had worse alcohol outcomes than those without a psychotic spectrum disorder . Individuals with a psychotic spectrum disorder had better alcohol-use outcomes on an active medication compared with placebo , but there was no clear advantage of disulfiram or naltrexone or of the combination .  Retention rates and medication compliance in the study were high and exceeded 80 % . Pharmacotherapeutic strategies should take into account the advantages and disadvantages of each medication . Future directions of pharmacotherapeutic options are also discussed BACKGROUND Although disulfiram and naltrexone have been approved by the Food and Drug Administration for the treatment of alcoholism , the effect of these medications on alcohol use outcomes and on psychiatric symptoms is still unknown in patients with co-occurring disorders post-traumatic stress disorder ( PTSD ) . METHODS Patients ( n = 254 ) with a major Axis I psychiatric disorder and comorbid alcohol dependence were treated for 12 weeks in a medication study at three Veterans Administration outpatient clinics . R and omization included ( 1 ) open r and omization to disulfiram or no disulfiram ; and ( 2 ) double-blind r and omization to naltrexone or placebo . This result ed in four groups : ( 1 ) naltrexone alone ; ( 2 ) placebo alone ; ( 3 ) disulfiram and naltrexone ; or ( 4 ) disulfiram and placebo . Outcomes were measures of alcohol use , PTSD symptoms , alcohol craving , GGT levels and adverse events . RESULTS 93 individuals ( 36.6 % ) met DSM-IV criteria for PTSD . Subjects with PTSD had better alcohol outcomes with active medication ( naltrexone , disulfiram or the combination ) than they did on placebo ;  overall psychiatric symptoms of PTSD improved . Individuals with PTSD were more likely to report some side effects when treated with the combination . CONCLUSIONS The results of this study suggest that disulfiram and naltrexone are effective and safe for individuals with PTSD and comorbid alcohol dependence AIMS In r and omized controlled trials with high internal validity , pharmacotherapy using acamprosate , naltrexone , and , to a somewhat lesser extent , disulfiram has proved effective in preventing relapse in patients with alcohol use disorders ( AUD ) . There remains , however , a paucity of studies with sufficient external validity in which the effectiveness of pharmacotherapy in clinical practice is investigated . This study aim ed to make a contribution to close this gap in research . METHODS In this naturalistic , prospect i ve study , a comparison on indices of substance use , psychiatric symptoms , and treatment service utilization was carried out using sample s of 92 patients who received pharmacotherapy and 323 patients who did not receive pharmacotherapy following discharge from 12 residential AUD programmes ( index stay ) . RESULTS Patients that received pharmacotherapy were more likely to use alcohol during the index stay and at the 1-year follow-up . Moreover , this patient group more readily utilized treatment services during a 2-year period prior to and a 1-year period following index stay than patients who were not given pharmacotherapy . Nevertheless , when pharmacotherapy was prescribed before first post-treatment alcohol use , it was associated with delay of alcohol use , fewer relapses , and a reduced need for inpatient treatment . In many cases , however , medication was not prescribed until alcohol use and relapse had occurred . The length of time to first alcohol use was longer , and the cumulative abstinence rate higher , for disulfiram than for acamprosate , the latter being generally prescribed for more severely alcohol-dependent patients . CONCLUSIONS There is a need for further studies to probe the reasons why medication for relapse prevention is not prescribed upon discharge from residential treatment and for less severely alcohol-dependent patients Thirty male alcoholic in patients received in a r and om double-blind design placebo ( P ) or disulfiram 250 mg . ( D ) at bedtime in order to evaluate the effects of the latter on EEG-EOG sleep patterns .  Subjects ( S 's ) had no major medical illness and required no medication for 3 weeks prior to the study . There were 13 disulfiram S 's and 17 placebo S 's . The total REM time decreased significantly ( p less than 0.05 ) in the D group . Total number of REM episodes decreased and latency to stage 1 REM increased in the disulfiram group . These results are characteristic of sleep patterns induced by the administration of catecholaminergics and opposite to those induced by catecholamine inhibiting agents Objective Alcohol abuse in patients with schizophrenia is associated with psychiatric and social complications . While two medications have been approved by the Federal Drug Administration ( FDA ) for the treatment of alcoholism : disulfiram and naltrexone , no medications have been approved for individuals with alcohol dependence and comorbid schizophrenia . The purpose of this study was to evaluate the efficacy of naltrexone in alcohol-abusing schizophrenic patients . Method Thirty-one patients with schizophrenia and comorbid alcohol abuse or dependence were treated for 12 weeks in an outpatient study using naltrexone or placebo in a r and omized , double-blind fashion in addition to their neuroleptic medication . Patients also participated in a weekly therapy using cognitive-behavioral drug relapse prevention strategies combined with skills training . Outcomes included drinking measured by the time line follow-back method , craving using the Tiffany Craving Question naire , psychotic symptoms using the Positive and Negative Symptoms Scale ( PANSS ) , side effects and a measures of abnormal involuntary movements . Results There were no significant differences in treatment exposure or medication compliance between groups . Naltrexone treated patients had significantly fewer drinking days , heavy drinking days ( > 5 drinks ) and reported less craving compared to the placebo treated patients . Naltrexone did not affect symptoms of schizophrenia , such as psychosis . The medication was well tolerated and there were no group differences in side effects . Conclusions These data suggest that naltrexone may be an effective medication for individuals with comorbid alcohol dependence and schizophrenia . Given the widespread problems associated with alcohol misuse in this population , and the lack of effective pharmacotherapies , these findings represent an exciting clinical development UNLABELLED Introduction Recent pharmacotherapy findings from new alcohol reduction programmes could change the paradigm of alcohol-dependence treatment . MATERIAL AND METHOD This study review s the neurobiological background and pharmacotherapy of alcohol-dependence disorder , focusing on opioid receptor antagonists , abstinence-oriented treatment and moderation-oriented treatment . RESULTS 1 . Alcohol-dependence treatment programs show only low to moderate efficacy . 2 . Patients usually show low motivation to sustain abstinence but high motivation to reduce alcohol use . 3 . A treatment program based on continued reduction of drinking and associated with intermittent treatment with naltrexone can be useful for low-severity alcohol-dependent patients . DISCUSSION Although high severity alcohol-dependent patients should stop drinking alcohol , low severity patients may have the option of reducing their alcohol consumption if they take an opioid antagonist medication every day that they decide to drink alcohol . In the short term , the continuing drinking-reduction programmes may reduce the number of drinks per drinking day and in the long term , they may progressively decrease the obsession for drinking , alcohol seeking behavior , and related medical , behavioral and social disorders . To change the paradigm in the treatment of alcohol-dependence disorder there is a need for further r and omized controlled trials in order to assess their efficacy and tolerability AIMS Sleep disturbance symptom ( SDS ) is commonly reported in alcoholic patients . Polysomnography studies suggested that acamprosate decreased SDS . We assessed this hypothesis by using data of a r and omized controlled trial . As a secondary objective , we suggested and tested the validity of a simple measurement of SDS based on the Hamilton depression and anxiety inventory subset . METHODS We re-analysed a multi-center study evaluating the efficacy of acamprosate compared with placebos on alcohol-dependent patients in concentrating on SDS change in time . The Sleep sum score index ( SAEI ) was built from check-lists on adverse effects reported at each visit and constituted our main endpoint . We also tested the validity of the short sleep index ( SSI ) defined by the four sleep items of the Hamilton depression and anxiety scales . Statistical analyses were conducted on an intention to treat basis . RESULTS A total of 592 patients were included , and 292 completed the 6-month trial . Compared with SAEI considered as our reference , the observed specificity and sensitivity of SSI were 91.6 and 87.6 % . From 40.2 % of patients experiencing SDS at baseline , this proportion decreased until 26.1 % at M6 in the placebo group and 19.5 % in the acamprosate group ( relative risk placebo/acamprosate = 1.49 , 95 % confidence interval 1.10 , 1.98 , P = 0.04 ) . CONCLUSION Treating alcoholic patients to enhance abstinence has a beneficial effect in reducing SDS , and the duration of abstinence during the treatment constitutes the main positive factor . An additional effect of acamprosate is conjectured from its effect on the glutamatergic tone . The SSI constitutes a simple , reasonably sensitive and specific instrument tool to measure SDS OBJECTIVE Substance abuse is extremely common in patients with bipolar disorders , although minimal data are available on the treatment of this important clinical population . Aripiprazole is an atypical antipsychotic that is approved for the treatment of mania and that has a novel mechanism of action , acting as a dopamine-2 receptor partial agonist , thereby increasing dopamine release in some parts of the brain and decreasing dopa-mine release in other brain regions . Dopamine release is implicated in substance use , and both dopaminergic agonists and antagonists have been examined for the treatment of substance abuse . To our knowledge , dopa-mine receptor partial agonists have not been investigated for treatment of substance abuse in humans . METHOD Twenty antipsychotic-treated patients with bipolar or schizoaffective disorder and current substance abuse were switched to open-label aripipra-zole using an overlap and taper method . At baseline , diagnoses were confirmed using the Mini-International Neuropsychiatric Interview based on DSM-IV criteria . Psychiatric symptoms , side effects , and substance use and craving were assessed over 12 weeks . Psychiatric symptoms were assessed with the Hamilton Rating Scale for Depression ( HAM-D ) , Young Mania Rating Scale ( YMRS ) , and Brief Psychiatric Rating Scale ( BPRS ) . Substance craving was assessed with visual analogue scales , and side effects were monitored using the Abnormal Involuntary Movement Scale , Simpson-Angus Scale , Barnes Akathisia Scale , and patient report .  Study enrollment was from April 2003 to February 2004 . RESULTS Significant baseline-to-exit improvement in HAM-D ( p = .002 ) , YMRS ( p = .021 ) , and BPRS ( p = .000 ) scores were observed without a significant change in antipsychotic-induced side effect scales . In 17 participants with current alcohol dependence , significant reductions in dollars spent on alcohol ( p = .042 ) and alcohol craving ( p = .003 ) were found . In 9 participants with cocaine-related disorders , significant reductions in cocaine craving ( p = .014 ) , but not use , were found . CONCLUSION A change to aripiprazole was associated with symptomatic improvement . Limitations of the study include a small sample size , high attrition , and an open-label design . Controlled trials in dual-diagnosis patients are needed to confirm these findings We investigated the effects of naltrexone ( NTX ) on  alcohol drinking , urge to drink alcohol , and alcohol-induced sensations and mood states in social drinkers consuming alcohol ad libitum in a cocktail bar . Sixteen college-age men and women participated in a double-blind , placebo-controlled , within-subjects , cross-over study . Subjects were tested during each of three drug conditions : NTX , 50 mg/ day , po ; inactive placebo ; and no drug . Each treatment condition lasted 8 to 11 days . Small groups of subjects consumed alcohol ad libitum during three 2-hr evening drinking sessions , separated by approximately-2 weeks . NTX treatment significantly increased the latency ( time in seconds ) to first sip the first ( p < 0.05 ) and second alcoholic beverages consumed ( p < 0.01 ) . Moreover , the mean blood alcohol concentration at the end of the session was significantly lower when subjects were treated with NTX ( p < 0.05 ) . No differences were found on self-report urge to drink alcohol . Subjects reported more fatigue and tension on the Profile of Mood States ( p < 0.05 ) , before drinking , and increases in nausea on the Alcohol Sensation Scale ( p < 0.05 ) when treated with NTX . The increase in the latency to sip the first and second alcoholic beverages may reflect the capacity of NTX to block urge for alcohol elicited from external cues ( before consuming alcohol ) , as well as urge for alcohol after priming from ingested alcohol . Thus , the effectiveness of NTX for reducing drinking behaviors of alcoholics may be partially caused by anticraving properties of NTX Abstract . Background : This laboratory study investigated the mechanisms by which the opioid antagonist , naltrexone , reduces the risk of relapse to heavy drinking in individuals with alcohol dependence . Methods : Eighteen alcohol-dependent , non-treatment-seeking volunteers were r and omized to 50 mg naltrexone or placebo for 6 days and participated in an alcohol self-administration experiment on the sixth day . Following baseline assessment s of craving and endocrine levels , subjects were first administered a priming drink design ed to raise blood alcohol levels to 0.03 g/dl and then had the opportunity to drink up to eight additional drinks or to receive US $ 3 for each drink not consumed over a 2-h period . Each additional drink was design ed to raise blood alcohol levels by 0.015 g/dl . Results : At baseline , naltrexone treatment result ed in higher cortisol levels and lower levels of craving than placebo treatment . Although there were no significant differences in response to the priming dose , naltrexone-treated subjects drank fewer drinks , consumed them more slowly , and reported lower levels of alcohol craving during the alcohol self-administration portion of the experiment . Naltrexone also result ed in higher levels of adrenocorticotropic hormone and cortisol than placebo treatment , and levels of cortisol were negatively correlated with intensity of alcohol craving . The number of drinks chosen was positively correlated with level of alcohol craving . Ratings of nausea were low and did not differ between the naltrexone and placebo groups at any point in the study . Conclusions : These results confirm the hypothesis that naltrexone reduces desire to drink and the amount of alcohol consumed in alcohol-dependent subjects . It is hypothesized that naltrexone may reduce drinking via suppressing craving for alcohol and that this effect may be related in part to naltrexone 's ability to activate the hypothalamo – pituitary – adrenocortical axis This study compared the efficacy of disulfiram ( DSF ) and topiramate ( TPM ) for preventing  alcoholic relapse  in an open study of routine clinical practice in India . One hundred alcohol-dependent men with family members who agreed to encourage medical compliance and to accompany them for follow-up were r and omly allocated to 9 months of treatment with DSF or TPM . Weekly psychotherapy was also provided . There was no blinding of conditions for the psychiatrist , patient , or family members . Supervision and support of the family member were used in the maintenance of compliance among the patients . Alcohol consumption , craving , and adverse events were recorded weekly for 3 months and then biweekly . Serum gamma glutamyl transferase was measured at the start and at the end of the study . At the end of the trial , 92 patients were still in contact .  Relapse occurred at a mean of 133 days for DSF as compared with 79 days for TPM . At 9 months , 90 % of DSF patients , as compared with 56 % of TPM patients , remained abstinent .  TPM-treated patients did show less craving than DSF patients did . Further comparisons between these drugs in different treatment setting s and patient population s are warranted OBJECTIVE Empirical evidence has only weakly supported antidepressant treatment for patients with co-occurring depression and alcohol dependence . While some studies have demonstrated that antidepressants reduce depressive symptoms in individuals with depression and alcohol dependence , most studies have not found antidepressant treatment helpful in reducing excessive drinking in these patients . The authors provide results from a double-blind , placebo-controlled trial that evaluated the efficacy of combining approved medications for depression ( sertraline ) and alcohol dependence ( naltrexone ) in treating patients with both disorders . METHOD A total of 170 depressed alcohol-dependent patients were r and omly assigned to receive 14 weeks of treatment with sertraline ( 200 mg/day [ N=40 ] ) , naltrexone ( 100 mg/day [ N=49 ] ) , the combination of sertraline plus naltrexone ( N=42 ) , or double placebo ( N=39 ) while receiving weekly cognitive-behavioral therapy . RESULTS The sertraline plus naltrexone combination produced a higher alcohol abstinence rate ( 53.7 % ) and demonstrated a longer delay before relapse to heavy drinking ( median delay=98 days ) than the naltrexone ( abstinence rate : 21.3 % ; delay=29 days ) , sertraline ( abstinence rate : 27.5 % ; delay=23 days ) , and placebo ( abstinence rate : 23.1 % ; delay=26 days ) groups . The number of patients in the medication combination group not depressed by the end of treatment ( 83.3 % ) approached significance when compared with patients in the other treatment groups . The serious adverse event rate was 25.9 % , with fewer reported with the medication combination ( 11.9 % ) than the other treatments . CONCLUSIONS More depressed alcohol-dependent patients receiving the sertraline plus naltrexone combination achieved abstinence from alcohol , had delayed relapse to heavy drinking , reported fewer serious adverse events , and tended to not be depressed by the end of treatment OBJECTIVE This 6-week open-label trial of naltrexone was conducted in a preliminary fashion to determine whether naltrexone would be safe , well tolerated , and lead to a reduction in alcohol consumption in adolescents with alcohol dependence . METHOD Five outpatient treatment-seeking adolescents who met Diagnostic and Statistical Manual of Mental Disorders , 4th edition ( DSM-IV ) criteria for alcohol dependence were recruited . The Child Schedule for Schizophrenia and Affective Disorders ( K-SADS ) , Structured Clinical Interview for DSM ( SCID ) , and the Family History Question naire were administered at baseline . The Time-Line Follow-Back ( TLFB ) and two craving scales ( Adolescent Obsessive Compulsive Drinking Scale [ A-OCDS ] and a craving analog scale ) were administered at baseline and weekly thereafter . Each subject received a 10-day supply of naltrexone ( 50 mg ) and a 100-mg riboflavin capsule . Subjects were instructed to take naltrexone and riboflavin simultaneously . RESULTS Overall , the average drinks per drinking day ( DDD ) decreased significantly from baseline to the end of week 6 with an average reduction of 7.61 st and ard drinks . There was a significant reduction in the average A-OCDS total score , A-OCDS Irresistibility subscale score , and craving analog score . Nausea was the only side-effect reported , and there were no elevations of liver enzymes .  Naltrexone was well tolerated by the alcohol-dependent adolescent . CONCLUSIONS Our data suggest that naltrexone is safe and well tolerated in adolescent alcoholics .  Naltrexone may lead to a significant reduction in alcohol consumption and craving in adolescent alcoholics , but larger , r and omized , controlled trials are needed Background Alcohol dependence comorbid with major depressive disorder poses a major challenge in the clinical setting . The results in the treatment with selective serotonin re-uptake inhibitors have been conflicting . Thus , we compared in alcohol-dependent patients with co-morbid major depressive disorder the selective serotonin re-uptake inhibitor escitalopram to a compound that acts on different transporter system and may reduce craving , the glutamate receptor antagonist memantine . Methods Eighty alcohol-dependent patients comorbid with major depressive disorder in municipal alcohol clinics were r and omized 1:1 to receive memantine 20 mg or escitalopram 20 mg in a double-blind manner . During the 26-week study period patients continued their routine treatment at the clinics . Abstinence was not required but encouraged . The patients attended visits weekly during the first month , and then at 3 and at 6 months . Outcome measures were Alcohol Use Disorders Identification Test ( AUDIT ) , Obsessive Compulsive Drinking Scale ( OCDS ) and Drinking Diary . Results The completion rate was high in both groups , especially among the patients who had been abstinent at the beginning of the study . However , among those patients who were not abstinent at baseline , 47 % in both groups discontinued the study . Numbers of abstinent days were high in both groups throughout the study . Alcohol consumption measured by the AUDIT QF ( quantity-frequency ) score was significantly reduced in both groups , as was the craving for alcohol measured by the OCDS . Early age at first alcohol intoxication predicted poor treatment outcomes in patients treated with escitalopram , and the same was seen with the early onset of the first depressive episode . The same predictive effects were not found in patients treated with memantine . Conclusion Our results indicate that both memantine and escitalopram are useful adjunct medications for the treatment of alcohol dependence co-morbid with major depression . Memantine was at least as effective with regard to drinking as escitalopram . We believe that a direct comparison of memantine , with the commonly used escitalopram , can provide useful information for clinicians on the treatment of alcohol dependency co-morbid with MDD.Trial registration Clinical Trials.gov Identifier # CONTEXT Medication for the treatment of alcoholism is currently not particularly robust . Neuroimaging techniques might predict which medications could be useful in the treatment of alcohol dependence . OBJECTIVE To explore the effect of naltrexone , ondansetron hydrochloride , or the combination of these medications on cue-induced craving and ventral striatum activation . DESIGN Functional brain imaging was conducted during alcohol cue presentation . SETTING Participants were recruited from the general community following media advertisement . Experimental procedures were performed in the magnetic resonance imaging suite of a major training hospital and medical research institute . PATIENTS Ninety non-treatment-seeking alcohol-dependent ( by DSM-IV criteria ) and 17 social drinking ( < 14 drinks per week ) paid volunteers recruited through advertisements at an academic center . INTERVENTIONS A taste of alcohol and a series of alcohol-related pictures , neutral beverage pictures , and visual control images were provided to volunteers after 7 days of double-blind r and omly assigned daily dosing with 50 mg of naltrexone ( n = 23 ) , 0.50 mg of ondansetron hydrochloride ( n = 23 ) , the combination of the 2 medications ( n = 20 ) , or matching placebos ( n = 24 ) . MAIN OUTCOME MEASURES Difference in brain blood oxygen level-dependent magnetic resonance when viewing alcohol pictures vs neutral beverage pictures with a particular focus on ventral striatum activity comparison across medication groups . Self-ratings of alcohol craving . RESULTS The combination treatment decreased craving for alcohol .  Naltrexone with ( P = .02 ) or without ( P = .049 ) ondansetron decreased alcohol cue-induced activation of the ventral striatum .  Ondansetron by itself was similar to naltrexone and the combination in the overall analysis but intermediate in a region-specific analysis . CONCLUSIONS Consistent with animal data that suggest that both naltrexone and ondansetron reduce alcohol-stimulated dopamine output in the ventral striatum , the current study found evidence that these medications , alone or in combination , could decrease alcohol cue-induced activation of the ventral striatum , consistent with their putative treatment efficacy
The only study available on disulfiram showed reduced REM sleep .
Acamprosate showed no/little effect on self-reported sleep but improved sleep continuity and architecture measured by polysomnography .
The two opioidergic drugs naltrexone and nalmefene had mainly detrimental effect on sleep , giving increased insomnia and /or somnolence compared with placebo , although not always significant .
The meta- analysis confirmed significantly increased somnolence and insomnia in the naltrexone group , compared with the placebo .
Overall , the currently available evidence s show more sleep problems with the opioidergic drugs ( especially naltrexone ) , while acamprosate seems to be well tolerated or even beneficial .
Acamprosate might be a more suitable choice when patients with AUD report sleep problems .
Background : Sleep disorders are commonly associated with acute and chronic use of alcohol and with abstinence .
To date , there are four approved drugs to treat alcohol use disorder ( AUD ) : disulfiram , acamprosate , naltrexone , and nalmefene .
These AUD therapies reduce the craving and risk of relapse into heavy drinking , but little is known about their effect on sleep .
As recent evidence s indicate a crucial role of sleep disorders in AUD , cl aim ing that sleep problems may trigger alcohol abuse and relapses , it is fundamental to clarify the impact of those drugs on the sleep quality of AUD patients .
This systematic review aims to answer the question : how does the pharmacotherapy for AUD affect sleep ?