Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism

Figures & data

Table 1 Recent clinical trials in bipolar disease with comorbid alcoholism

Study	Design	Drug	Sample (n)	Observation period	Effect size
Sattar^Citation16,Citation32	Open label trial	Valproate	20 SUDP (Alcohol n = 10)	24 weeks	Halved both, SUD days (BS) and YMRS score (BS)
Reoux et al^Citation17*	Double-blind, placebo-controlled trial	Valproate (V) Placebo (P)	13 (5 HAP) 14 (7 HAP)	12 weeks	Relapses: 0 (V) vs 3 (P) in HAP patients (SS)
Rubio et al^Citation22	Open label trial	Lamotrigine	28	24 weeks	30% to 70% reduction in all outcome measures (SS)
Brown et al^Citation33	Randomized, double blind, placebo-controlled	Quetiapine (Q) Placebo (P)	52 50	12 weeks	HRSD: −10.1 (V) vs −9.0 (P) (SS). NS for alcohol use
Martinotti et al^Citation34	Open label trial	Quetiapine	28 MDP (BP = 16)	16 weeks	SS reductions in all alcohol outcome measures (alcohol free MDP = 43%)
Davis et al^Citation36*	Randomized, double blind, comparative study	Risperidone vs Valproate	30	12 weeks	NS differences in alcohol outcome measures
Brown et al^Citation38	Open label trial	Naltrexone	34	16 weeks	SS improvement in HRSD (−28%), YMRS (−34%) and alcohol outcome measures (−50%)
Salloum et al^Citation39	Randomized, open label trial	Naltrexone/valproate vs valproate alone	21		More abstinence with naltrexone/valproate (71.4%) than with valproate alone (43%)
Frye et al^Citation37*	Single-blind randomized trial	Valproate vs olanzapine	50	52 weeks	Valproate superior (P = 0.02) to olanzapine in reducing alcohol relapse in women, but not in men

Notes:

* Results reported in the form of a meeting abstract.

Abbreviations: SUDP, patients with substance use disorders; HAP, patients with high anxiety; HRSD, Hamilton Rating Scale for Depression; MDP, patients with mood disorders; BP, patients with bipolar disorders; SS, statistically significant; BS, borderline statistical significance; NS, nonstatistically significant.

Table 2 Recommendations for the management of bipolar disorder in comorbidity with alcoholism⁶³

In case of alcohol abuse, reduce alcohol consumption to normal when possible. In case of failure or in case of alcohol-dependence, proceed to alcohol withdrawal. Following alcohol withdrawal, alcohol-dependence and bipolar disorder should be simultaneously treated. Use valproate as first treatment choice. Inform the patient about the interaction between alcoholism and bipolar disorder, insisting about the depressive risk. Rationalize the myth of alcohol as auto-medication.^Citation63 Provide psycho-education about situations favoring mood disorder episodes or substance use. Evaluate treatment discontinuation or misuse.

SattarSPValproate in the treatment of bipolar disorder and comorbid substance abuse: a 24-week open lable trialBiol Psychiatry20076146S

 Web of Science ®Google Scholar

SattarSPSchultzSKArndtSSoundyTPettyFLong-term adjunctive quetiapine may reduce substance use–a preliminary retrospective studySouth Dakota Med200760439441

 Google Scholar

ReouxJPMalteCAFarrCLFergusonLCSaxonAJControlled trial of extended release divalproex sodium in alcohol dependent patients with subsyndromal psychiatric symptoms18Th annual meeting and symposium of the American Academy of Addiction Psychiatry (AAAP)2007Hotel Del Coronado, Coronado, CA, USA

 Google Scholar

RubioGLópez-MuñozFAlamoCEffects of lamotrigine in patients with bipolar disorder and alcohol dependenceBipolar Disord20068283293

 Web of Science ®Google Scholar

BrownESGarzaMCarmodyTJA randomized, double-blind, placebo-controlled add-on trial of quetiapine in outpatients with bipolar disorder and alcohol use disordersJ Clin Psychiatry20086970170518312058

 PubMed Web of Science ®Google Scholar

MartinottiGAndreoliSDi NicolaMDi GiannantonioMSarchiaponeMJaniriLQuetiapine decreases alcohol consumption, craving, and psychiatric symptoms in dually diagnosed alcoholicsHuman Psychopharmacol Clin Exp200823417424

 PubMed Web of Science ®Google Scholar

DavisLLLiXGarnerCBiladeauJUstinovYUezatoADivalproex ER versus risperidone for bipolar disorder with comorbid substance use disorderWashington, DC161st Annual Meeting of the American Psychiatric AssociationMay 3–8, 2008

 Google Scholar

BrownESBeardLDobbsLRushAJNaltrexone in patients with bipolar disorder and alcohol dependenceDepress Anxiety20062349249516841344

 PubMed Web of Science ®Google Scholar

SalloumIMDouaihyACorneliusJRDaleyDCKellyTMKirisciLOpen label randomized pilot study of combined naltrexone and valproate in bipolar alcoholicsAlcohol Clin Exp Res200630140A16433742

 PubMed Web of Science ®Google Scholar

FryeMAChirichignoJWMcKowenJA single-blind evaluation of divalproex sodium vs olanzapine for alcohol abuse relapse prevention in bipolar disorderDon Cesar Beach Resort, FLAAAP Annual Meeting and SymposiumDec 7–10, 2006

 Google Scholar

BrousseGGarayRPBenyaminaAManagement of comorbid bipolar disorder and alcohol dependencePresse Med2008371132113718296020

 PubMed Web of Science ®Google Scholar