A combination of antidepressants, alcohol counseling and behavioral therapy may help curb violent tendencies in men with drinking problems, a small clinical trial suggests.
U.S. government researchers found that adding the antidepressant fluoxetine (Prozac) to alcohol treatment and behavioral therapy worked better than the latter two alone in reducing anger and aggression among alcoholic men with a history of violence toward their partners.
The clinical trial was small—only 24 men completed the study—and lasted only three months, but the findings lay the groundwork for larger trials, according to Dr. David T. George and colleagues at the National Institute on Alcohol Abuse and Alcoholism.
If the current results are confirmed, they say, antidepressant therapy could help improve treatment of alcohol-dependent perpetrators of domestic violence.
It’s estimated that as many as 70 percent of domestic-violence perpetrators have an alcohol-abuse problem.
As it stands, behavioral therapy is the typical treatment for abusers—often in the form of court-mandated batterer intervention programs. But studies suggest that such programs do little to curb violent behavior, George and his colleagues note.
For their study, reported in the Journal of Clinical Psychiatry, the researchers recruited 60 men who were seeking treatment for alcoholism and had a history of physically abusing their “significant other.”
All of the men underwent treatment for their alcohol dependence, including behavioral therapy and support from self-help groups, like Alcoholics Anonymous. They also received individualized cognitive- behavioral therapy to address their domestic violence; the goal was to help them recognize the “perceived threats” in their lives that typically spurred their aggression and develop non-violent ways to deal with them.
In addition to those therapies, half of the men were randomly assigned to take fluoxetine everyday for three months. The rest were given placebo capsules and served as a “control” group.
Overall, only 24 men completed the three-month study; many of those who dropped out did so because they had started drinking again and were readmitted for in-patient treatment.
Still, the researchers found, of the men who did complete the study, those on the antidepressant showed greater reductions on a standard measure of anger, irritability and aggressive behavior.
When the men’s spouses and partners were surveyed about any physical and non-physical abuse they’d suffered during the study period, the researchers found that men in both the antidepressant and placebo groups improved to a similar degree.
According to George’s team, the rationale behind giving antidepressants in this context is that perpetrators of domestic violence have been shown to have a “heightened sensitivity” to environmental stressors, with a possible role for chemical messengers in the brain such as serotonin, which is involved in regulating mood.
Fluoxetine is in the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which are designed to enhance the action of serotonin in the body. It is approved by the U.S. Food and Drug Administration for major depression, obsessive-compulsive disorder, and other conditions, and is available as an inexpensive generic drug.
The current study appears to be the first to test a medication for treating perpetrators of domestic abuse, according to George and his colleagues. Many questions remain—including whether the short-term changes in the antidepressant group’s self-reported anger and aggression translate into fewer violent incidents over time.
Larger studies, the researchers write, are needed to determine whether fluoxetine or other SSRIs have a role in curbing aggressive behavior in people with alcohol problems.
They note that ongoing studies using brain-imaging technology known as functional MRI are investigating the ways in which fluoxetine affects brain function in perpetrators of domestic abuse.
SOURCE: Journal of Clinical Psychiatry, online June 29, 2010.
