Pharmacological Management of a Teen With Significant Alcohol Use and Depression

• NCJ Number: 215177
• Journal: Journal of the American Academy of Child & Adolescent Psychiatry Volume: 45 Issue: 8 Dated: August 2006 Pages: 1011-1015
• Author(s): Christopher J. Kratochvil M.D.; Alessandra Kazura M.D.; Deborah Deas M.D.; Catherine A. Martin M.D.; Tyanne Dosh M.S.; Timothy E. Wilens M.D.
• Date Published: August 2006
• Length: 5 pages
• Publication Format: Article
• Publication Type: Report (Study/Research)
• Language: English
• Country: United States of America

Annotation

This paper presents recommendations from three physicians regarding the pharmacological (prescription medicines) management of a 16-year-old girl referred by her parents because of her significant alcohol use, which involved drinking to intoxication three times a week, despite attempts to limit use, and recently experiencing blackouts.

Abstract

One physician recommends that pharmacological management be combined with evidence-based psychosocial treatments for both depression and alcohol use. The physician notes that the U.S. Food and Drug Administration (FDA) have approved three medications for the treatment of alcohol dependence in adults only: naltrexone, acamprosate, and disulfiram. She advises that there is insufficient evidence at this time to support use of these medicines in the first-line treatment of alcohol-use disorders in adolescents. Any decision to use these medicines with adolescents requires thoughtful consideration of the risks and benefits of use for each individual and attention to the limitations of current knowledge about their safety and effectiveness. A second doctor advises that because of the large consumption of alcohol by the girl, a medication that decreases alcohol consumption should be considered. She notes that naltrexone has been examined in an open-label fashion in adolescents and proved to decrease both craving and alcohol consumption. Adolescents in the trial were able to tolerate 50 mg/day after starting at 25 mg/day. Given the girl's depressive symptoms, the doctor also recommends that an antidepressant medication be considered. Psychosocial therapies are recommended in combination with medications. The third physician also recommends a comprehensive treatment plan that includes pharmacological interventions for various symptoms, including naltrexone to reduce alcohol craving and fluoxetine to decrease depressive symptoms and alcohol use. 13 references