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The usefulness of selective serotonin reuptake inhibitors (SSRIs) to treat alcohol dependence continues to be a subject of debate. Most recently, investigations have tried to predict whether a given patient will respond to SSRIs in terms of reducing excessive alcohol drinking. The subtyping of alcohol-dependent individuals has ranged from relatively simple classifications (e.g., presence of comorbid depression) to more complex classifications (e.g., potential to have abnormalities in serotonin [5-HT] neurotransmission). Although only a few studies have been completed, results thus far indicate that alcoholic subgroups are differentially responsive to 5-HT pharmacotherapy with respect to drinking-related outcomes. In addition, there are preliminary results encouraging the use of SSRIs in combination with other medications for treating alcohol dependence in patients with and without comorbid psychiatric disorders. Information from these studies is promising, suggesting the need for further investigation.

Clinical profiles of alcohol-dependent male and female outpatients were evaluated at treatment entry to compare the level of clinical severity in alcoholics with a coexistent comorbid depressive disorder to alcoholics who have never been depressed. Due to a higher proportion of females than males in the depressed alcoholic population, selected patient groups were oversampled to create a study group with equivalent number of males and females with and without comorbid depression. Clinical severity was assessed by examining both the extent of alcohol problems, and depressive symptomatology at treatment entry with respect to gender differences (unrelated to depression), effects of comorbid depression (unrelated to gender), and effects from the interaction of gender and depression. There were 93 DSM-III-R alcohol-dependent outpatients (50 males, 43 females), half of whom had a current or lifetime DSM-III-R depressive disorder. The amount of drinking in the 90 days before treatment entry, the degree of alcohol severity, and the number of lifetime drinking-related consequences were collected in the first week after detoxification. Diagnoses of lifetime and current depression were determined via the Structured Clinical Interview for DSM-III-R, and depressive symptoms were evaluated with rating scales 1 week after detoxification. In most cases, a depressive disorder was diagnosed only if sometime in the patient's history depressive symptoms had either predated problem drinking or been present during a 6-month abstinent period.depressed males had a more severe clinical profile with respect to their alcoholism (i.e., more drinking, drinking-related problems, and alcohol severity than depressed females and never-depressed males). Surprisingly, females who had never been depressed (also no family history of depression) reported drinking the same quantities of alcohol in the 90 days before treatment and had comparable alcohol severity and number of consequences as males who had never been depressed. Depressed females, however, were more severely depressed (i.e., reported more intensive depressive symptoms than depressed male alcoholics). Thus, determining the type and extent of clinical severity at treatment entry in comorbidly depressed alcoholics depends on the gender of the patient The significant interaction between gender and the presence of comorbid depression that was found in this study may have important implications for predicting success in treatment.

Electroconvulsive therapy (ECT), a safe and effective treatment for major depression, has been more harshly criticized than any other psychiatric treatment. Despite widespread negative public opinion, clinical impressions that are supported by limited empirical data suggest that patients who benefit from ECT do not share these negative sentiments. This study surveyed attitudes toward ECT in 78 depressed inpatients, twice during hospitalization and at 6 months after discharge, using a semi-structured interview. Significantly more ECT-treated patients (n = 56) were favorable about ECT, compared to depressed patients (n = 22) never treated with ECT, both at pretreatment (chi square = 8.4, df = 1, p.01) and at post-treatment (chi square = 12.5, df = 1, p.01). Favorable attitudes were maintained after 6 months. ECT-treated patients, initially uncertain or negative about ECT, changed to a favorable attitude after completing treatment. Ninety-eight percent of ECT-treated patients said they would agree to ECT if they became depressed again.

Dexamethasone, compared to placebo in a double-blind study, failed to prevent the memory deficiency that typically accompanies electroconvulsive therapy (ECT) (n = 48 patients treated for DSM-III diagnosed major depressive disorder). Rather, the administration of the drug was associated with attention (p less than 0.02) and short-term memory (p less than 0.0003) difficulties in both bilateral and unilateral ECT patients. Bilateral ECT plus dexamethasone patients had significantly less improvement (p less than 0.05) in their depression (measured by the Hamilton Depression Scale) compared to bilateral ECT plus placebo patients. These depression differences were not seen among unilateral ECT patients.

The Squire Self-rating Scale of Memory Function was administered to 28 depressed inpatients before and after electroconvulsive therapy (ECT), with random assignment to bilateral or unilateral electrode placement. Several memory changes differentiated between bilateral and unilateral ECT following treatment (p less than 0.05). Memory complaints arising from ECT were distinguished from those due to depression.