Brady K T, Sonne S C, Roberts J M
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425, USA.
J Clin Psychiatry. 1995 Nov;56(11):502-5.
Posttraumatic stress disorder (PTSD) often co-occurs with alcohol dependence, yet little is known about treatment of this comorbidity. The serotonin selective reuptake inhibitors have been shown preliminarily to be effective in decreasing symptoms of PTSD but have not been studied in individuals with comorbid alcohol dependence. This is of particular interest as the SSRIs also have a modest effect in decreasing alcohol consumption.
In this preliminary trial, nine subjects with comorbid PTSD and alcohol dependence were treated in an open-label trial with sertraline for a 12-week period. Symptoms of PTSD and depression were monitored monthly with the Impact of Event Scale and the Hamilton Rating Scale for Depression (HAM-D). Alcohol consumption was monitored by a self-report instrument (Time-Line Follow-Back).
There were significant decreases in all three symptom clusters of PTSD measured by overall PTSD symptom scores (p < or = .001) and in HAM-D scores (p < or = .001) during the follow-up period. Days of abstinence increased and average number of drinks decreased during the follow-up period. Four subjects claimed total abstinence during the follow-up period.
While limited by small sample size and the open-label, nonblinded study design, this study suggests that sertraline may be useful in the treatment of PTSD complicated by alcoholism. The medication was well tolerated and subjects showed improvement in PTSD symptoms as well as decreased alcohol consumption. A controlled trial of sertraline in this population would be of interest.
创伤后应激障碍（PTSD）常与酒精依赖同时出现，但对于这种共病的治疗知之甚少。血清素选择性再摄取抑制剂已初步显示对减轻PTSD症状有效，但尚未在合并酒精依赖的个体中进行研究。鉴于选择性5-羟色胺再摄取抑制剂（SSRI）在减少酒精摄入量方面也有一定作用，这一点尤其值得关注。
在这项初步试验中，9名患有PTSD和酒精依赖共病的受试者参加了一项为期12周的舍曲林开放标签试验。每月使用事件影响量表和汉密尔顿抑郁量表（HAM-D）监测PTSD和抑郁症状。通过自我报告工具（时间线追溯法）监测酒精摄入量。
在随访期间，通过PTSD总体症状评分测量的PTSD所有三个症状群均有显著下降（p≤0.001），HAM-D评分也有显著下降（p≤0.001）。随访期间戒酒天数增加，平均饮酒量减少。4名受试者在随访期间声称完全戒酒。
尽管本研究受样本量小以及开放标签、非盲法研究设计的限制，但表明舍曲林可能对治疗并发酒精中毒的PTSD有用。该药物耐受性良好，受试者的PTSD症状有所改善，酒精摄入量也有所减少。对该人群进行舍曲林对照试验将很有意义。
