Farren Conor K, O'Malley Stephanie
Department of Psychiatry, Yale University School of Medicine, New Haven, Conn, USA.
Am J Addict. 2002 Summer;11(3):228-34. doi: 10.1080/10550490290088009.
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.
纳曲酮作为辅助维持阿片类药物戒断的药物已使用了30年，但成效有限。原因之一是，与酒精成瘾不同，纳曲酮似乎无法减轻阿片类药物成瘾者的渴望。作者开展了此项纳曲酮与选择性5-羟色胺再摄取抑制剂（SSRI）舍曲林联合使用的试验，以评估联合药物疗法的治疗持续性。他们采用双盲安慰剂对照试验，让13名近期无抑郁症状的阿片类药物成瘾戒断者参与，一组每天服用50毫克纳曲酮加安慰剂，另一组每天服用50毫克纳曲酮加50毫克舍曲林，为期12周。两组的副作用情况相似，联合治疗组最初有治疗持续性增加的趋势，但研究结束时，两组在治疗持续性上并无差异。随着时间推移，两组的贝克抑郁量表评分均有所下降，联合治疗组的贝克抑郁量表评分与治疗时长之间存在显著负相关。通过阿片类药物渴望问卷测量发现，两组的阿片类药物渴望均随时间下降。作者得出结论，联合药物疗法耐受性良好，相对于单独使用纳曲酮，最初在提高治疗持续性方面取得了成功，但这种效果会随着时间减弱。
