Zoloft Works for Some Alcoholics, Not All

Anti-Depressant Works Best for Less Severe Alcoholics

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Zoloft Can Help Less Severe Alcoholics. &copy Getty Images

One of the ways that alcohol can affect the brain is by damaging the functioning of serotonin, a chemical that influences mood, sleep, appetite, temperature regulation and mood.

Consequently, patients with alcohol problems often report problems with depression and anxiety. Their healthcare providers will typically prescribe selective serotonin reuptake inhibitors (SSRIs) to help them maintain optimal levels of serotonin.

"SSRIs are the most widely prescribed class of anti-depressants," said William Dundon, senior research investigator in the department of psychiatry at the University of Pennsylvania School of Medicine. "SSRIs work by affecting the level of serotonin in the brain and elsewhere in the body. In the brain, serotonin is thought to influence mood, emotions, sleep, appetite, and temperature regulation."

Research has found, however, that SSRIs, such as sertraline (Zoloft), do not work well for some alcoholics.

Zoloft Doesn't Work for All Alcoholics

To determine why SSRIs help some patients with alcohol use disorders and not others, Dundon and colleagues examined two categories of alcoholics defined by Thomas Babor of the University of Connecticut.

Babor divided individuals with alcohol problems into two groups, Type A and Type B. Type A alcoholism is environment-based and generally occurs later in life, while Type B alcoholism is genetics based and arises early in life.

Type B Alcoholism Is More Severe

According to Babor's research, Type B alcoholism tends to have a greater adverse impact than Type A alcoholism. Generally speaking Type B alcoholism is more severe and higher risk than Type A alcoholism.

During the study, 100 alcoholics were given a three-month course of either sertraline (200 mg/day) or placebo capsules and AA-based individual therapy.

The 55 Type A alcoholics and the 45 Type B alcoholics were interviewed about their alcohol consumption.

Zoloft Helps Type A Alcoholics

The researchers compared monthly alcohol consumption for the six months following treatment to alcohol consumption during the last month of treatment.

Dundon's study found that Type A alcoholics had a better treatment response to Zoloft than did Type B alcoholics.

During the six months following treatment, Type A alcoholics treated with Zoloft maintained their gains, while Type B alcoholics did not.

Maintained Positive Results

Specifically the Dundon study found:

  • Type A alcoholics who took Zoloft maintained, for at least six months after treatment ceased, the positive results they obtained during treatment
  • Type B alcoholics treated with Zoloft continued to show no pharmacotherapeutic benefits during the six-month period following treatment.
  • For Type B alcoholics, heavy drinking actually increased during the six months following treatment with Zoloft.

SSRIs Not Appropriate for Type Bs

"We appear to have identified a subgroup of alcoholics, Type As, who responded well to sertraline during treatment and maintained their gains over a six-month period after ending treatment," said Dundon.

"However, there is another subgroup, Type Bs, for whom SSRIs may not be appropriate. This subgroup seemed to maintain their gains from the AA-based individual therapy only if they had not received sertraline," he said.

The reason the researchers examined Babor's two types of alcoholics is due to previous research that suggested that there were differences in serotonin metabolism between the two groups.

Did Not Respond to Zoloft

Type B alcoholics were found to have more abnormalities in serotonin metabolism, in the earlier study, and it was thought that group would therefore be more likely to respond to Zoloft treatment.

However, the Type B alcoholics did worse on the SSRI treatment and during the six-month, post-treatment period.

Implications for Alcoholism Treatment Plans

The researchers concluded that being able to determine whether alcoholics entering treatment are either Type A or Type B could be helpful in developing a treatment plan.

"I think our study clearly suggests that there may be ways to subtype alcoholics, and that these different subgroups of alcoholics may respond differently to the same treatment," said Dundon. "Numerous classification schemes have been proposed to differentiate types of alcoholics. Our study supports the usefulness of the Babor Type A and Type B classification system.

Study Confirms Babor's Type A and B Alcoholics

Later research by the Public Health Institute and the University of California, San Francisco using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) confirmed that Type A and Type B alcoholics exist in real life.

The study found that Type B alcoholics in the general population, compared to Type As, had higher alcohol severity and more co-occurring drug, mental, and physical health problems.

Type B alcoholics were twice as likely to be alcohol dependent three years later and more likely to be heavy drinkers and drug dependent.


Babor, et al. "Types of alcoholics: concurrent and predictive validity of some common classification schemes." Addiction January 2006

Dundon, W. et al. "Treatment Outcomes in Type A and B Alcohol Dependence 6 Months After Serotonergic Pharmacotherapy." Alcoholism: Clinical & Experimental Research May 2004

Tam, TW, et al. "Applicability of Type A/B alcohol dependence in the general population." Drug and Alcohol Dependence May 2014

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