Adamson 2015.

Methods	Randomized, double‐blind, placebo‐controlled trial
Participants	138 depressed people with alcohol dependence (56 men and 82 women; mean (± SD) age 43.6 ± 9.1 years). Inclusion criteria: aged 17‐65 years current DSM‐IV diagnoses of alcohol dependence and depression MADRS score > 20 Exclusion criteria: past regular intravenous drug use for > 2 weeks recreational use of any opioid drugs in the previous 4 weeks or a current requirement for ongoing opioid use psychosis, including psychotic delirium complicating alcohol or other drug withdrawal mania or hypomania significant current suicidality or homicidality current severe psychiatric symptoms requiring hospitalization, unstable physical disease use of disulfiram, naltrexone, antidepressant, or mood stabilizing medication in past 4 weeks serum AST, ALT, or GGT greater than 3 × the upper limit of laboratory reference range, or a bilirubin level > upper limit of reference range pregnancy, breastfeeding, or unwillingness to use a reliable method of contraception in women of childbearing age current or pending imprisonment Participants with bipolar disorder were excluded.
Interventions	Drugs: citalopram (up to 60 mg/day) + naltrexone (up to 100 mg/day) (73 participants; 29 men and 44 women) placebo + naltrexone (up to 100 mg/day) (65 participants; 27 men and 38 women) Psychotherapy: manualized clinical case management was delivered by experienced addiction clinicians. Scheduled duration of treatment: 12 weeks Sites: 7 addiction clinics spanning urban, provincial, and rural catchments in Australia. Setting: outpatients Route of administration: orally Starting dose: citalopram: 20 mg/day in week 1; if tolerated, dose then increased to 40 mg/day. After 6 weeks, dose could be further increased to 60 mg/day if participants remained depressed naltrexone: 25 mg daily for 1 week, then increased to 50 mg in participants without significant adverse effects. Dose could be further increased to 75 mg or 100 mg after 6 weeks Pattern of dose reduction: information not available
Outcomes	Depression: final MADRS score final SCL‐90 score remission Alcohol dependence: rate of abstinent days number of heavy drinking days per week (obtained from the rate of heavy drinking days) number of drinks per drinking day final LDQ score Dropouts Adverse effects
Notes	Baseline characteristics of participants Depression: primary depression (% of participants): 76.1% duration (years): 19.3 MADRS score (mean ± SD): 31.0 ± 5.8 Alcohol dependence: number of drinks per drinking day (mean ± SD): 14.3 ± 8.0 duration (years): 13.8 being actively drinking: participants were not required to be abstinent Other psychiatric comorbidity: 47.1% of participants had current anxiety disorder. Other substance‐use disorders: 14.5% of participants had current substance dependence. Other characteristics of study Other pharmacological treatment offered: all participants received naltrexone. Funding sources: study funded by Health Research Council of New Zealand grant HRC 07/138. Declaration of interest: authors declared no conflict of interest.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomization was performed using a computer‐generated random number table.
Allocation concealment (selection bias)	Low risk	Treatment allocation was conducted by an administrative staff member independent of study investigators or research clinicians, and the allocation sequence record was stored securely.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	The investigators, doctors, participants, and any other staff members taking part in the experiment were unaware which of the groups any particular participant belonged to.
Blinding of outcome assessment (detection bias) objective	Low risk	No information on blinding of outcome assessors.
Blinding of outcome assessment (detection bias) subjective	Unclear risk	No information on blinding of outcome assessors.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Missing data were imputed using appropriate methods.
Selective reporting (reporting bias)	Unclear risk	Numbers of dropouts per group were missing.