Summary of findings 3. Nortriptyline (antidepressant) versus placebo.

Nortriptyline (antidepressant) versus placebo
Patient or population: men with alcohol dependency Setting: inpatient and later outpatient; USA Intervention: nortriptyline (oral, 25 to 75 mg/day) Comparison: placebo
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	Number of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with placebo	Risk with nortriptyline
Aggression	‐	‐	‐	‐	‐	No data available
Reconviction	‐	‐	‐	‐	‐	No data available
Global state/functioning Measured by: Global Assessment of Functioning Scale (scores range from 0‐100, with higher scores indicating better functioning) and the General Severity Index (GSI) subscale of the Symptom Check List‐90 (GSI), which uses mean of subscale scores (range from 0‐4, with higher scores indicating greater severity of symptoms) Follow‐up: end of treatment (6 months)	There was no difference in GSI mean scores between participants taking nortriptyline (0.3) and those taking placebo (0.7)		‐	20 (1 RCT)	⊕⊝⊝⊝ Very lowa	‐
Social functioning	‐	‐	‐	‐	‐	No data available
Adverse events	‐	‐	‐	20 1 (RCT)	‐	No data available. One study measured side effects, however it did not report data on adverse events for the ASPD subgroup in either condition
*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). AsPD: Antisocial personality disorder; CI: Confidence interval
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect

^aEvidence downgraded three levels. We downgraded one level due to limitations in the design/implementation, suggesting possible risk of bias (attrition bias, selection bias, allocation bias and blinding of outcome assessor bias), and two levels due to very serious imprecision due to optimal information size criterion not being met and non‐reporting of outcome data.