Pharmacotherapeutic options for co-morbid depression and alcohol dependence

ABSTRACT

Introduction: Depression and alcohol dependence are frequently co-morbid and among the most prevalent mental disorders. They are a serious global health problem with social, interpersonal, and legal interpolations. Among pharmacological alternatives, anti-craving compounds as well as antidepressants, antipsychotics, anticonvulsants, benzodiazepines, and beta-blockers have shown efficacy for depression as well as alcohol consumption. The pharmacological treatment of both complex interwoven mental diseases is still challenging given the inconsistent results of open and double-blind randomized placebo-controlled studies with approved and open label medications.

Areas covered: The authors provide a systematic review of the literature with PubMed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to obtain an overview of the pharmacotherapeutic options for co-morbid depression and alcohol dependence.

Expert opinion: The effect of treating only depressive or alcohol-related symptoms appears limited. Therapies directly targeting the addiction are warranted among such dually diagnosed patients. Despite limited data, the reviewed pharmacotherapeutic treatments demonstrated efficacy in most but not in all relevant parameters of alcohol dependence and depression.

KEYWORDS:

• Alcohol dependence
• anticraving compounds
• antidepressants
• depression
• pharmacotherapy

Article highlights

• Our review supports the clinical use of pharmacological treatment of people with co-occurring depression and AUD although the clinical relevance may be modest.

• Antidepressants had a positive effect on most but not all relevant outcomes related to major depression and AUD.

• Psychopharmacological options targeting multiple neurotransmitter systems showed promising results although the clinical evidence is weak.

• Although not approved for the treatment of AUD or monopolar depression, there is some evidence for the use of anticonvulsants.

• Acamprosate, naltrexone, and baclofen showed mixed findings in our reviewed trials with no clear efficacy on major depression and AUD. The results for disulfiram are more promising and suggest an added benefit on alcohol use as well as on depression.

• The results for antidepressants, anticonvulsants, and antipsychotics as well as NMDA receptor blockers confirm that many aspects of AUD involve changes in multiple neurotransmitter systems.

• Combinations of antidepressants with approved medications in the treatment of people with co-occurring depression and AUD were auspicious; additional evidence is warranted.

• New insights in the pathology and pharmacogenetics of patients with AUD and comorbid depression will allow more personalized treatment.

This box summarizes key points contained in the article.

Acknowledgements

We want to thank Katrin Wolf for help in literature search and assistance in writing the manuscript.

Declaration of interest

T Hillemacher has received speaker´s honoraria from Lundbeck, Desitin, Otsuka, Servier, Janssen Cilag and Amomed while H Frieling has received speaker’s honoraria from Otsuka, Servier and Janssen Cilag. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.