CHICAGO – Paroxetine can take the anxiety out of the drinker, but it cannot 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.
“These patients were precontemplators for their alcohol use disorder,” said Dr. Book, a psychiatrist at the Medical University of South Carolina, Charleston. “They wanted us to fix their anxiety symptoms but weren't interested in addressing their alcoholism.”
Her 16-week randomized controlled trial, funded by the National Institute of Alcohol Abuse and Alcoholism, pitted paroxetine (60 mg) against placebo in 42 patients with severe generalized anxiety and comorbid alcohol use disorders. The patients could have had no previous alcohol detoxification treatment. “We wanted to examine the effect of the drug in people who were early in their alcoholism career, to see if we could intervene in the progression,” she said.
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 per week.
By week 16, patients in the treatment group had a far greater decrease in their LSAS scores than did those in the placebo group (53% vs. 32%). But a different picture emerged when Dr. Book examined the drug's effect on drinking.
All patients completed a study-specific questionnaire that asked how often they drank to cope before and during social situations. 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, no differences were found between the groups in either frequency of drinking or quantity consumed.
GlaxoSmithKline Inc. provided the study medication.