The pharmacotherapeutic management of comorbid bipolar disorder and alcohol use disorder

ABSTRACT

Introduction

Comorbidity of bipolar disorder (BD) and alcohol use disorder (AUD) is very frequent resulting in detrimental outcomes, including increased mortality. Diagnosis of AUD in BD and vice versa is often delayed as symptoms of one disorder mimic and obscure the other one. Evidence for pharmacotherapies for people with comorbid BD and AUD remains limited, and further proof-of-concept studies are urgently needed.

Areas covered

This paper explores the currently available pharmacotherapies for AUD, BD and their usefulness for comorbid BD and AUD. It also covers to some degree the epidemiology, diagnosis, and potential common neurobiological traits of comorbid BD and AUD.

Expert opinion

The authors conclude that more controlled studies are needed before evidence-based guidance can be drawn up for clinician’s use. Since there are no relevant pharmacological interactions, approved medications for AUD can also be used safely in BD. For mood stabilization, lithium should be considered first in adherent persons with BD and comorbid AUD. Alternatives include valproate, lamotrigine, and some atypical antipsychotics, with partial D2/D3 receptor agonism possibly being beneficial in AUD, too.

KEYWORDS:

• Alcohol use disorder
• bipolar disorder
• comorbidity
• dual disorder
• epidemiology
• pharmacotherapy
• substance use disorder

Article highlights

• Alcohol use disorder (AUD) exceeds other comorbidities by far in people with bipolar disorder (BD).

• Both AUD and BD have devastating consequences for the course of illness, the psychosocial impact, and physical health resulting in excess mortality.

• Established treatments, both psychosocial and pharmacological, are available for each distinct disorder; however, the evidence for best treatments of comorbid BD and AUD is still scarce, especially for pharmacotherapies.

• For the time being and until better evidence has been generated, clinical wisdom and practice tells to treat AUD and BD independently rather than trying to find a “one fits all purposes” medication.

Disclosure statement

Over the past 36 months, H Grunze has received grants/research support, consultancy fees and honoraria from Janssen- Cilag, Sanofi and Servier. Meanwhile, over the same period, M Soyka has worked as a consultant for and/or has received grants from Indivior, Lundbeck, Camurus and Mepha Pharma AG. 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.