A pilot double blind placebo controlled trial of sertraline with naltrexone in the treatment of opiate dependence.

Naltrexone has been used for thirty years as an aid to maintenance of opiate abstinence with limited success. One reason is that naltrexone does not appear to reduce craving in opiate addiction, unlike in alcoholism. The authors conducted this trial of naltrexone in combination with the SSRI sertraline to assess treatment retention with combination pharmacotherapy. They used a double-blind placebo controlled trial of naltrexone 50 mg qd with placebo versus naltrexone 50 mg plus sertraline 50 mg qd in 13 recently nondepressed abstinent opiate addicts followed over a 12 week period. Both groups had a similar side effect profile and while there was an initial trend in increased retention in the combination therapy group, there was no difference in retention by the end of the study. There was a fall in the Beck Depression Inventory scores in both groups over time, and there was a significant negative correlation between BDI scores and duration in treatment in the combination therapy group. There was a fall in opiate craving, as measured by an opiate craving questionnaire, over time in both groups. The authors conclude that combination pharmacotherapy appeared to be well tolerated and was initially successful in increasing treatment retention relative to naltrexone alone, but this effect tended to diminish over time.