Alcohol dependence is extremely common in patients with bipolar disorder, and it is associated with unfavorable outcomes, including treatment nonadherence, violence, and cognitive impairment. However, few treatment trials have been conducted in this population. Quetiapine is an atypical antipsychotic medication that is used to treat the mood symptoms of bipolar disorder. In this study, the efficacy of quetiapine in reducing alcohol use and improving mood symptoms was assessed in patients with bipolar disorder and alcohol abuse or dependence.
One hundred fifteen outpatients with bipolar disorder and alcohol abuse or dependence were randomly assigned to 12 weeks of quetiapine (titrated to 600 mg/day) add-on therapy or placebo. Alcohol use and mood were assessed. The study was conducted from November 2002 to September 2005.
One hundred two participants (49% with bipolar I disorder, 82% depressed, and 97% with alcohol dependence) returned for at least 1 postbaseline assessment and were used in the random regression analysis. No statistically significant between-group differences were found on alcohol use measures or the Young Mania Rating Scale. However, based on a random regression analysis, scores on the Hamilton Rating Scale for Depression (HAM-D) decreased statistically significantly more in the quetiapine than in the placebo group during the trial (p < .05). The between-group difference was largely due to differences in HAM-D scores during the first 6 weeks of the trial, with the placebo group showing greater improvement during the second half of the trial.
Quetiapine therapy was associated with a statistically significant decrease in depressive symptoms, but not alcohol use, in patients with bipolar disorder and alcohol dependence (p < .05).
"An RCT comparing quetiapine (303 + 152 mg/day) with risperidone (3.1 + 1.2 mg/day) reported that both medications improved psychiatric symptoms and stimulant cravings (Nejtek et al., 2008) (Ib). An RCT of add-on quetiapine (600 mg/day) found no improvement in alcohol use or craving in those with bipolar disorder and alcohol abuse or dependence (Brown et al., 2008) (Ib). An open trial that included patients with alcohol dependence and bipolar disorder (n = 10), or schizoaffective disorder (n = 2) and/or borderline personality disorder (n = 10) found that quetiapine alone improved psychiatric symptoms, and decreased alcohol consumption and craving (Martinotti et al., 2008) (IIb). "
[Show abstract][Hide abstract] ABSTRACT: The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.
Journal of Psychopharmacology 05/2012; 26(7):899-952. DOI:10.1177/0269881112444324 · 3.59 Impact Factor
"However, it is important to note that positive clinical trials involving dually diagnosed patients have been scarce, and attempts to replicate such positive findings have not been uniformly successful. For example, though Brown et al. (2008) found that quetiapine reduced depressive symptoms in bipolar alcoholics, these findings were not replicated in a subsequent multi-site clinical trial (Stedman et al., 2010). In contrast, our results regarding the impact of anxiety disorders on clinical outcomes are largely consistent with previous investigations. "
[Show abstract][Hide abstract] ABSTRACT: Despite the high prevalence and detrimental impact of alcoholism on bipolar patients, the diagnostic and treatment factors associated with better or worse clinical outcomes in alcohol-dependent patients with bipolar disorder are not well understood. The present study investigated the prospective impact of baseline psychiatric comorbidities and treatment regimens on clinical outcomes in bipolar alcoholics. Data were drawn from an 8-week randomized controlled clinical trial of acamprosate for individuals (n=30) with co-occurring bipolar disorder and alcohol dependence. Depressive and manic symptoms, and alcohol craving and consumption were monitored longitudinally using standardized instruments. Path analysis was used to estimate the prospective associations between patient characteristics and outcomes. More than 50% of patients were diagnosed with at least one anxiety (76.7%) or drug dependence disorder (60.0%). Comorbid anxiety disorders were prospectively associated with increased depressive symptoms and alcohol use. Participants were prescribed an average of 2.6 psychotropic medications at baseline. Antipsychotics and anticonvulsants were prospectively associated with increased alcohol use; anticonvulsants and benzodiazepines were associated with increased alcohol craving. Antidepressants were associated with increased depressive symptoms. Conversely, lithium was associated with decreased alcohol craving and depressive symptoms. The findings from the present study suggest areas for future research in this population.
Psychiatry Research 06/2011; 188(3):361-5. DOI:10.1016/j.psychres.2011.04.030 · 2.47 Impact Factor
"There appears to be more evidence for a depression treatment response than an alcohol treatment response (Nunes and Levin, 2004) in depressed alcoholics. For bipolar alcoholics, there has been some evidence for pharmacotherapy treatment efficacy (Salloum et al., 2005; Brown et al., 2008), but there are few well-controlled studies. Some of the research problems in dually diagnosed alcoholic patients include: poor measurement of substance abuse or psychiatric outcomes, small sample sizes and low completion rates (Tiet and Mausbach, 2007). "
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to examine prospectively examined predictors of relapse in alcohol dependence with comorbid affective disorder.
One hundred and eighty-three unipolar depressed or bipolar alcoholics who completed an integrated inpatient treatment programme for dual diagnosis were assessed at baseline, post-treatment discharge and at 3 and 6 months post treatment. Backwards stepwise likelihood ratio multiple logistic regression was used to investigate the impact of multiple covariates on relapse to alcohol in the 0-3- and 3-6-month period post discharge.
The retention rate at 3 months post discharge was 95.3% (177 patients) and at 6 months it was 87.4% (162 patients). Higher level of anxiety at baseline and discharge was significantly associated with relapse at 3, but not at 6 months, in all subjects. Higher baseline alcohol use disorder identification test scores were associated with relapse at 3 and at 6 months. Intention and planning to attend aftercare after discharge from the hospital were associated with non-relapse at 3 and 6 months, respectively. Levels of depression, of elation and of craving at baseline were not significantly predictive of relapse. Those who had relapsed at 3 months were significantly more likely to remain drinking at 6 months. Rehospitalization within the first 3 months post discharge appeared to be protective against further relapse.
Baseline patient factors, including levels of anxiety, appear to play a significant role in relapse to alcohol in this difficult to treat population.
Alcohol and Alcoholism 11/2010; 45(6):527-33. DOI:10.1093/alcalc/agq060 · 2.89 Impact Factor
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