The End of My Addiction

were referred to the Institute of Internal Medicine, Rome, Italy. 84 were randomly allocated either oral baclofen or placebo for 12 weeks. Primary outcome was proportion of patients achieving and maintaining alcohol abstinence. Measures of this outcome were total alcohol abstinence and cumulative abstinence duration, which were assessed at outpatient visits. Relapse was defined as alcohol intake of more than four drinks per day or overall consumption of 14 or more drinks per week over a period of at least 4 weeks. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov , number NCT00525252.
    Findings
    Of 42 patients allocated baclofen, 30 (71%) achieved and maintained abstinence compared with 12 (29%) of 42 assigned placebo (odds ratio 6·3 [95% CI 2·4–16·1]; p = 0·0001). The number of dropouts (termination of treatment) did not differ between the baclofen (6/42 [14%]) and placebo (13/42 [31%]) groups (p = 0·12). Cumulative abstinence duration was about twofold higher in patients allocated baclofen than in those assigned placebo (mean 62·8 [SE 5·4] vs 30·8 [5·5] days; p = 0·001). No hepatic side-effects were recorded.
    Interpretation
    Baclofen is effective at promoting alcohol abstinence in alcohol-dependent patients with liver cirrhosis. The drug is well tolerated and could have an important role in treatment of these individuals.

Baclofen and Anxiety
    Abstract 1
    Breslow, M. F., Fankhauser, M. P., Potter, R. L., et al. (1989) Role of gamma-aminobutyric acid in antipanic drug efficacy.
    American Journal of Psychiatry 146, 353–356.
    All effective pharmacologic agents used to treat panic disorder augment gamma-aminobutyric acid (GABA) transmission. Anxiolytics and antidepressants that lack GABA activity are not effective in panic disorder. To test the hypothesis that GABA activity is a component of antipanic drug efficacy, the authors treated nine medication-free panic disorder subjects with oral baclofen (30 mg/day for 4 weeks) in a double-blind, placebo-controlled crossover trial. Baclofen, a selective GABA agonist, was significantly more effective than placebo in reducing the number of panic attacks and scores on the Hamilton anxiety scale, Zung scale, and Katz-R nervousness subscale. The authors discuss possible mechanisms of antipanic drug efficacy.

 
    Abstract 2
    Krupitsky, E. M., Burakov, A. M., Ivanov, V. B., et al. (1993) Baclofen administration for the treatment of affective disorders in alcoholic patients.
    Drug and Alcohol Dependence 33, 157–163.
    Ninety alcoholic patients with the secondary affective disorders (anxiety, depression) were divided into four groups. Patients in the first group received GABA B receptor ligands (baclofen), those in the second group, diazepam, those in the third group, amitriptyline and those in the fourth group, placebo. The results of clinical, psychological (tests of Spielberger, Zung and MMPI), and electrophysiological (superslow omega-potential) investigations showed that baclofen is an effective drug for affective disturbances in alcoholic patients, with efficacy superior to placebo and equal to diazepam and amitriptyline. At the same time baclofen does not have the side-effects and complications of the latter. Significant changes in platelet MAO B activity and the dopamine, serotonin and GABA concentrations in blood after treatment were not found in the four patient groups. The peripheral metabolism of GABA and monoamines do not seem to be related to the development of secondary affective disorders in alcoholic patients. This investigation encourages the search for drugs acting on the affective psychopathology of GABA B receptor ligands.

 
    Abstract 3
    Drake, R. G., Davis, L. L., Cates, M. E. et al. (2003) Baclofen treatment for chronic posttraumatic stress disorder.
    The Annals of Pharmacotherapy 37, 1177–1181.
    Objective
    Previous studies have shown the efficacy of gamma-aminobutyric acid B (GABA B ) receptor agonists in treating anxiety in patients with panic disorder and in treating depression and anxiety in alcoholic patients. We hypothesized that baclofen, a GABA B agonist, would be an effective treatment in the symptomatic management of veterans with chronic posttraumatic stress disorder (PTSD).
    Methods
    Fourteen male veterans with chronic, combat-related PTSD were enrolled in an open-label, 8-week, monotherapy trial of baclofen titrated to a maximum of 80 mg/d in 3 divided doses. The primary outcome measure was