Fluoxetine Treatment of Alcoholic Perpetrators of Domestic Violence: A 12-Week, Double-Blind, Randomized, Placebo-Controlled Intervention Study

Objective: Behaviorally based therapies for the treatment of perpetrators who initiate intimate partner violence (IPV) have generally shown minimal therapeutic efficacy. To explore a new treatment approach for IPV, we examined the effects of a selective serotonin reuptake inhibitor on the irritability subscale score of the Modified Overt Aggression Scale. This score served as a surrogate marker for the anger and physical aggression that characterize perpetrators of IPV.

Method: A 12-week, double-blind, randomized, placebo-controlled intervention study employing fluoxetine, alcohol treatment, and cognitive-behavioral therapy was performed. Sixty (46 men) non-court-mandated, DSM-IV-diagnosed alcoholic perpetrators of IPV with a history of at least 2 episodes of IPV in the year prior to participation in the study were evaluated. The primary outcome measure was the score on the irritability subscale of the Modified Overt Aggression Scale. Secondary measures included anxiety, depression, and ratings by the perpetrator’s spouse/significant other. The study was conducted from January 2002 through December 2007.

Results: A repeated-measures analysis of variance using the irritability subscale scores obtained from perpetrators who completed the 12-week study (n = 24) showed a significant drug effect (F1,21 = 12.09, P = .002). Last observation carried forward (F1,32 = 4.24, P = .048) as well as intent-to-treat analysis (F1,54 = 5.0, P = .034) also showed a significant drug effect. Spouses’ /significant others’ physical and nonphysical Partner Abuse Scale ratings showed a significant reduction of abuse over time (F1,11 = 10.2, P = .009 and F1,11 = 24.2, P = .0005, respectively).

Conclusion: This is the first controlled study to show that a pharmacologic intervention employing a selective serotonin reuptake inhibitor, in conjunction with alcohol treatment and cognitive-behavioral therapy, can reduce measures of anger and physical aggression in alcoholic perpetrators of IPV.

Trial Registration: clinicaltrials.gov Identifier: NCT00011765

J Clin Psychiatry

Submitted: March 30, 2009; accepted July 20, 2009.

Online ahead of print: June 29, 2010 (doi:10.4088/JCP.09m05256gry).

Corresponding author: David T. George, MD, Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bldg 10, Clinical Research Center, Room 2-2352, 10 Center Drive, Bethesda, MD 20892-1540 (tedg@mail.nih.gov).