CHICAGO — Paroxetine can take the anxiety out of the drinker, but it can't take the drinking out of the anxious person.
The drug did uncouple anxiety and drinking in patients who use alcohol to cope with severe generalized social anxiety, Dr. Sarah Book said at the annual meeting of the Research Society on Alcoholism. But compared with placebo, paroxetine (Paxil) had no effect on overall alcohol consumption.
Her 16-week randomized controlled trial pitted paroxetine (60 mg) against placebo in 42 patients with severe generalized anxiety and comorbid alcohol use disorders. The patients had no previous alcohol detoxification treatment. We wanted to see if we could intervene in the progression and prevent worsening of alcohol use, said Dr. Book, a psychiatrist at the Medical University of South Carolina, Charleston.
The patients' average age was 29 years; 50% were male. At baseline, their mean score on the Leibowitz Social Anxiety Scale (LSAS) was about 90, indicating severe social anxiety. Anxiety had its onset at age 12 years in these patients; the use of alcohol to cope with symptoms followed about a decade later. They were moderately dependent on alcohol, consuming about 15 drinks a week.
By week 16, the patients in the treatment group had a significantly greater decrease in their LSAS scores than did those in the placebo group (53% vs. 32%).
All of the patients completed a study-specific questionnaire on how often they drank to cope before and during social situations, and how often they would avoid such situations if they could not drink to cope. At week 16, those in the paroxetine group had significantly lower scores than did those in the placebo group, with 20% (vs. 40%) saying they still drank to cope with social situations, and 30% (vs. 70%) saying they would avoid such situations if they couldn't drink.
But when Dr. Book examined the total overall drinking, she found no differences between the groups in either frequency of drinking or quantity consumed. “We [also] saw no difference from baseline to week 1, a very important milestone in most alcohol treatment studies, and no change in drinking from baseline to end point.”
A subanalysis confirmed that paroxetine uncoupled drinking and anxiety symptoms, Dr. Book said. When anxiety scores and drinking were plotted together for all patients, it was apparent that the drug reduced drinking to cope with social anxiety. “This relationship completely went away in the paroxetine group. Yet they continued to drink the same amount overall. For these people, something else is going on to maintain their alcohol use disorder.”
GlaxoSmithKline Inc. provided the study medication; the study was funded by the National Institute of Alcohol Abuse and Alcoholism.