[The impact of the central serotonin system on alcoholism and therapeutic consequences]

Several studies support the assumption that the development and/or maintenance of alcoholism is due to a deficit of the central serotonergic system. But it still remains open whether the imbalance in the serotonergic functioning is due to genetic factors or whether it is a result of alcoholism. It has been hypothesised that both mechanisms interact with each other creating a vicious circle. The efficacy of serotonin reuptake inhibitors (SSRIs) in treating alcoholism supports the pathophysiological assumptions. Citalopram (40 mg) and Fluoxetine (60-80 mg) significantly reduce ethanol intake. However, treatment effects disappear after a treatment period of more than 4 weeks in most of the studies. Chronic and heavy alcoholics benefit less from treatment. Better treatment results were obtain in alcoholics with primary depression, especially with a prolonged treatment period. The promising treatment outcome in primary depressed alcoholics suggests an efficacy of SSRIs in alcoholism with primary anxiety disorders, although no data are available. The results of the studies in this field support the following therapeutic consequences: 1. Alcoholics with primary depression should be treated with SSRIs. 2. A short-term treatment with SSRIs in primary alcoholism without comorbid psychiatric diseases can be considered, e.g. to prevent treatment drop-outs or for relapse prevention. 3. So far, treatment in alcoholics with primary anxiety disorders is not supported simply due to a complete lack of data. Studies on this problem are imperative.