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Alcoholism, also
known as alcohol dependence is the most common disorder seen. There are
different types of alcohol dependence, it could me mild to severe. Individuals who
are alcohol dependent tend to prioritize drinking alcohol over all the other activities.

Alcoholism is a condition that comes in an individual life without knowing that
they have become dependent to alcohol. An individual on a mild stage of alcohol
dependent may start craving an alcoholic drink when it is not available and may
find it hard to stop drinking when it is available. Individuals who go through severe
alcohol dependence may start seeing changes in their physical and/or
psychological withdrawal symptoms, such as vomiting, anxiety when they are not
on alcohol.  

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An
individual is classified in the category of alcohol dependent when one drinks
over the standard limit. The recommendation according to the guidelines from
CDC to reduce alcohol dependence a men should not consume an alcohol drink no
more than two per day and for women is no more than 1 drink per day. In this
discussion, we will focus on the difference in responses of men versus women in
the pharmacologic therapy of alcoholism treated by agent Citalopram. Citalopram
belongs to the Selective serotonin reuptake inhibitor, known as SSRI drug
class. They work by reducing the neuronal uptake of serotonin which results in
higher synaptic concentrations.

The
placebo-controlled study was performed to see the effects of citalopram as an
effective treatment for alcoholism.  The study
included sixty-one individuals including 34 men and 27 women. The study was
done over a 12-week period where they were given 40mg citalopram every day to
15 women subjects and 16 men versus placebo to the rest of the individuals.  For this clinical trial, the participants were
selected on the basis if they are medically and socially stable, they had an
intake of at least 28 drinks per week for at least the past 3 months. They also
needed to be a candidate who fit in the category of mild to moderate alcohol
dependence according to the ADS and the diagnostic and statistical manual of
mental disorder, 3rd edition, revised (DMS-III-R)2 .

Participants were also not chosen for the trial if they were diagnosed with
clinical depression, an anxiety disorder or any other psychiatric disorder
requiring treatment, including abuse of or dependence on another drug(s)2 .

The patients were divided into the citalopram group and the placebo group and
were monitored over the course period of 2 weeks.

In
the trial, the author was trying to examine the craving for alcohol and how citalopram
will help with this craving. To be effective in the study, participants were
divided according to the gender, male vs. female, and were examined the effects
of citalopram over alcohol consumption compared to placebo. The groups were
randomly assigned to receive: 1) citalopram 40mg per day and brief psychosocial
intervention (BPI) for 12 weeks or 2) daily placebo and BPI for 12 weeks. In
order to see the adherence of the subjects to the medication/placebo regimen,
the urine samples were taken every day 2 to 4 hours following their administration
of medication and/or placebo. The subjects were asked to take the medication at
8pm, so the urine sample was take 2 to 4 hours after the administration. Ethanol
and riboflavin concentrations were checked in the urine sample to see the
adherent of the medication. BPI behavioral psychosocial intervention was also
performed on the participants where they met with a therapist on 4 scheduled
treatment visits for about 1.25 hours to discuss the progress of the treatment.

The
primary outcome of the trial was analyzed by 2-way ANOVA test which indicated
that men receiving citalopram reduced their alcohol consumption way more than
women receiving citalopram (P<0.05). The reason for this significance difference is unknown, but there have been reports that shows that there might be a difference in 5-HT2 serotonin receptor binding where men shows significant higher binding capacity than women. The data provided with the study does conclude that the percentage decreased in drinks per day for men, there have been less craving for alcohol seen in men with this trial. The second randomized double blind trial also hypothesized the effects of citalopram over decreasing the desire, and craving of alcohol. This trial included the participants between age 26 to 69 who where they included 13 men and 3 women healthy, non- depressed alcohol-dependent drinkers. The participants were assessed over a 4 week of therapy and were then cross-over with placebo giving them a 1 week of washout period. The daily intake of alcohol, non-alcoholic drinks and tobacco use were recorded. The participants were asked to take the citalopram at 8pm and their urine was drawn 2 to 4 hours after the administration to check the compliance by checking the ethanol and riboflavin concentrations in urine as the test was done on the outpatient setting. The use of citalopram 40 mg therapy was assessed in two ways:- 1) a 4-week outpatient trial and 2) a drinking session in an experimental bar 3  .  In the outpatient setting, patient were returned back to the clinic for assessment every 7 days and were then crossed over with the placebo therapy and vice-versa. When the participants returned back for their weekly assessment, they were assessed on their number of drinks per day, their desire to drink, craving and the liking for alcohol. The measurement scale by Fraser et al3 was used to assess the severity of the likeliness of drinking. On a 15 cm scale on which 0 = not at all, 1 = slight, 2= moderate, 3 = a lot, and 4 = an awful lot.

Patients were also assessed during their experimental bar sessions where they
had to drink the 18 minidrinks (equivalent to 6 drinks) to assess their
behavior of desireness to drink. This particular trial did not focus on the
difference between men versus women drinking recommendations, but rather it was
more focused on generalized decreased in the number of drinks due to the
effects of citalopram.  The test was assessed
by 3-way ANOVA variance where the results stated that there is significant
decrease in the mean daily drinks during the citalopram (mean +/- SEM = 4.6 +/-
0.6) compared to placebo (5.7 +/- 0.8)3 . The effect on alcohol
intake is not attributable to the antidepressant action of the drugs. The mechanism
of action of SSRI has not been determined yet. However, the study showed 12 out
of 16 participants decreased their alcohol intake during the citalopram
administration compared to placebo.

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