Zorick Todd, Okita Kyoji, Renard K Brooke, Mandelkern Mark A, Brody Arthur L, London Edythe D
Department of Psychiatry and Biobehavioral Sciences, UCLA, USA.
Lundquist Institute at Harbor-UCLA Medical Center, USA.
Psychiatry J. 2022 Sep 20;2022:5663274. doi: 10.1155/2022/5663274. eCollection 2022.
Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for patients who misuse alcohol, especially in the context of comorbid depressive symptoms. Deficits in impulse control and decision-making are linked to routine alcohol consumption and alcohol dependence. The goal of this study was to determine the effects of a single dose of citalopram on measures of impulsivity, decision-making, and/or brain dopamine receptor availability in alcohol-dependent individuals. A double-blind, placebo-controlled, within-subject, outpatient study was conducted with active alcohol-dependent (DSM-IV-TR criteria) participants ( = 12) and matched healthy controls ( = 13). Serial doses of both citalopram (40 mg) and saline were administered intravenously before laboratory tests of decision-making (Balloon Analogue Risk Task, delay discounting task, and Loss Aversion Gambling Task) and positron emission tomography with [F]-fallypride to measure dopamine D receptor availability, separated by at least one week. Alcohol-dependent participants demonstrated greater loss aversion than healthy controls, but there were no group differences in risk taking on the Balloon Analogue Risk Task. Citalopram increased delay discounting across groups, with no group difference in the effect. There were no effects of citalopram on risk taking on the Balloon Analogue Risk Task. PET showed a negative correlation between thalamic dopamine D receptor availability and loss aversion across groups. The effect of citalopram to decrease the valuation of monetary reward as a function of delay raises the possibility that SSRIs can influence risky decision-making in clinical populations. In addition, these results suggest that altered thalamic dopamine signaling may play an important role in disproportionately valuing losses in patients with Alcohol Use Disorder. This trial is registered under ClinicalTrials.gov registration NCT01657760.
选择性5-羟色胺再摄取抑制剂（SSRIs）通常被开给酗酒的患者，尤其是在伴有抑郁症状的情况下。冲动控制和决策方面的缺陷与常规饮酒及酒精依赖有关。本研究的目的是确定单剂量西酞普兰对酒精依赖个体的冲动性、决策能力和/或脑多巴胺受体可用性指标的影响。对符合酒精依赖（DSM-IV-TR标准）的12名门诊患者及13名匹配的健康对照者进行了一项双盲、安慰剂对照、受试者自身对照的门诊研究。在进行决策实验室测试（气球模拟风险任务、延迟折扣任务和损失厌恶赌博任务）以及用[F]氟哌利多进行正电子发射断层扫描以测量多巴胺D受体可用性之前，静脉注射西酞普兰（40毫克）和生理盐水的系列剂量，两次注射间隔至少一周。酒精依赖参与者比健康对照者表现出更强的损失厌恶，但在气球模拟风险任务中的冒险行为上两组没有差异。西酞普兰增加了各组的延迟折扣，且在效果上没有组间差异。西酞普兰对气球模拟风险任务中的冒险行为没有影响。PET显示，各组中丘脑多巴胺D受体可用性与损失厌恶之间呈负相关。西酞普兰降低货币奖励延迟估值的作用增加了SSRIs可能影响临床人群风险决策的可能性。此外，这些结果表明，丘脑多巴胺信号改变可能在酒精使用障碍患者对损失的过度重视中起重要作用。本试验已在ClinicalTrials.gov注册，注册号为NCT01657760。
