The role of serotonergic agents as treatments for alcoholism

Serotonergic agents remain an important area of pharmacologic study as treatments for alcoholism. Selective serotonin reuptake inhibitors (SSRIs) do not appear to be efficacious at treating a heterogeneous alcoholic group. SSRIs may, however, possess utility in treating later-onset alcoholics and alcoholism that is complicated by co-morbid major depression. The 5-HT(1A) partial agonist, buspirone, does not appear to be an efficacious treatment for alcoholics without co-morbid disease. Buspirone may, however, possess some utility in treating alcoholics with co-morbid anxiety disorder. Ritanserin, a 5-HT(2) antagonist, does not appear to be an efficacious treatment for alcoholism at pharmacologically relevant clinical doses. Ondansetron, a 5-HT(3) antagonist, is an efficacious and promising medication for the treatment of earlier-onset alcoholism. The differential treatment effect of SSRIs and ondansetron among various subtypes of alcoholics is intriguing. Future research is needed to more clearly understand the biopsychosocial differences that typify a particular alcoholic subtype. This type of understanding could develop our ability to make reasonable predictions as to what alcoholic subtype would respond best to a particular serotonergic agent, which could then be provided.