Citalopram Effects on Craving and Dopamine Receptor Availability in Alcoholics
Condition: Alcohol Dependence
MeSH terms: Alcoholism
Intervention: citalopram
Intervention description: citalopram, 40 mg IV, vs. saline control, each to be administered in a double-blinded, within-subjects design.
Intervention MeSH terms: Citalopram
Phase: Phase 1
Study type: Interventional
Primary purpose: Basic Science
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Participant, Investigator)
Enrollment: 31.0
Sex: All
Minimum age: 21 Years
Maximum age: 55 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: craving; dopamine; citalopram; ssri

Summary:

      Alcohol use disorders (AUDs) are highly prevalent among U.S. civilians, and even more
      prevalent in the U.S. Veteran population. AUDs are frequently co-morbid with depressive
      symptoms in psychiatric clinical populations, resulting in an increased severity of both
      conditions. Indeed, returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)
      Veterans have extraordinarily high rates of alcohol misuse and co-morbid psychiatric
      symptoms, indicating that future Veteran clinical populations will be particularly affected
      by AUDs. While FDA-approved medications are available to treat AUDs, their efficacy is low
      compared to available psychosocial treatments. Despite the lack of evidence for efficacy from
      controlled trials, antidepressants are frequently prescribed to clinical populations
      (including Veterans) with active AUDs. A better understanding of patient-level clinical
      variables that may confer poor response to treatment with antidepressants would allow
      clinicians better tools to distinguish those alcohol-dependent Veterans likely to do worse
      with antidepressant treatment.
    

Eligibility criteria:

        Inclusion Criteria:

        Must be U.S. Veteran

        Alcohol Dependence:

          -  Age between 21 and 55;

          -  Meeting DSM-IV diagnostic criteria for alcohol dependence;

          -  Report drinking at least 48 standard drinks in a 30-day period, during the 90 days
             before enrollment, and

          -  Must have had at least 2 days of heavy drinking (at least 5 drinks/day for men, 4
             drinks/day for women) in the last 30 days

        Healthy Control:

          -  Age between 21 and 55;

          -  No Axis I DSM-IV diagnosis (except for nicotine dependence);

          -  Report drinking less than 10 drinks weekly over the past 90 days prior to study entry
             by Timeline Followback Method (TLFB).

        Exclusion Criteria:

        Exclusion criteria for Alcohol Dependence:

          -  Current treatment for alcohol problems or a history of treatment in the 30 days before
             enrollment or are treatment seeking;

          -  A current (last 12 months) DSM-IV diagnosis of dependence on any psychoactive
             substances other than alcohol and nicotine.

        Exclusion criteria for Healthy Controls:

          -  Any history of treatment for alcohol or other substance use disorders;

          -  Any history of DSM-IV diagnosis of dependence on any psychoactive substances other
             than nicotine;

          -  Any history of DSM-IV diagnosis of Axis I mental illness.

        Exclusion criteria for all subjects:

          -  A current (last 12 months) DSM-IV diagnosis of schizophrenia, bipolar disorder, other
             psychotic disorder, eating disorder, panic disorder with or without agoraphobia;

          -  Current use of psychoactive drugs, other than occasional marijuana use (< 3 uses per
             week), as determined by a positive urine screen for narcotics, amphetamines, or
             sedative hypnotics;

          -  Serious alcohol withdrawal symptoms as indicated by a score > 10 on the Clinical
             Institute Withdrawal Assessment for Alcohol-Revised (CIWA);

          -  Clinically significant physical abnormalities as indicated by physical examination,
             hematological laboratory assay, or urinalysis, defined as: hematology and chemistry
             laboratory tests that are within normal (+/- 10%) limits with the following
             exceptions: a) liver function tests (total bilirubin, alanine transaminase [ALT],
             aspartate aminotransferase [AST], and alkaline phosphatase) < 3 x the upper limit of
             normal, and b) kidney function tests (creatinine and BUN) < 2 x the upper limit of
             normal;

          -  A screening ECG that demonstrates anything other than normal sinus rhythm, normal
             conduction, and no clinically significant arrhythmias;

          -  History of epilepsy, seizures, or severe head trauma;

          -  History of alcohol intoxication delirium, alcohol withdrawal delirium or seizure,
             alcohol-induced persisting dementia, or alcohol-induced psychosis;

          -  Treatment with any of the following medications within the last 30 days prior to
             randomization: antidepressants, anti-convulsants, hypnotics, antipsychotics,
             psychomotor stimulants, or anti-anxiety agents;

          -  Previous treatment with citalopram discontinued due to an adverse event;

          -  Pregnancy, nursing, or refusal to use reliable barrier method of birth control, if
             female;

          -  Presence of metal fragments, pacemaker, or other ferromagnetic material which would
             prevent safe completion of an MRI scan;

          -  Recent history of radiation exposure which would make exposure to radiation from
             serial PET scans contraindicated;

          -  Non-zero breath-alcohol level on screening. We will exclude participants who present
             to study appointments intoxicated, as active alcohol intoxication may interact
             unpredictably with citalopram and produce unreliable results in assessments of mood or
             alcohol craving (e.g. Ray and Hutchison, 2007; Ray et al., 2011; see preliminary data
             C.2. above);

          -  Resting vital signs on any study visit outside of acceptable parameters: Pulse of
             50-105 bpm, Blood pressures of 90-160 mm Hg systolic, 55-100 mm Hg diastolic;

          -  Any indication of suicidal ideation (i.e. as assessed by question 9 on the Beck
             Depression Inventory-II [BDI-II]), or elevated index of depressive symptoms, as
             evidenced by BDI-II score of 20;

          -  Presence in the body of a metal device (e.g., pacemaker, infusion pump, aneurysm clip,
             metal prosthesis or plate) that could either interfere with the acquisition of the MRI
             scan of the brain or for whom the MRI scan would pose a potential risk will be
             excluded.

          -  Radiation exposure: Participation in any other research study involving exposure to
             ionizing radiation in the past year if the total cumulative exposure from the past
             research studies and the current research study would exceed the limits described by
             the FDA in 21 CFR 361.1. Specifically, the total cumulative dose to the whole body,
             active blood-forming organs, lens of the eye, and gonads must remain below 5 rems, and
             the cumulated dose to all other organs must remain below 15 rems over the last year.