A Randomized, Double-Blind, Placebo-Controlled Add-On Trial of Quetiapine in Outpatients With Bipolar Disorder and Alcohol Use Disorders

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

“…Two large, 12-week RCTs (n = 362 and n = 115) of adjunctive quetiapine in patients with BD and comorbid alcohol abuse or dependence did not show significant improvements in measures of alcohol use and dependence compared to placebo, although depressive symptoms improved in one trial (322,323). A 12-week RCT of adjunctive naltrexone in 50 patients with BD I or BD II and comorbid alcohol dependence demonstrated a trend toward greater decrease in alcohol-related outcomes compared to placebo (324).…”

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

“…In these last three years, the only randomized, clinically relevant study in bipolar patients with comorbid alcoholism is that of Brown and colleagues 33 showing that quetiapine therapy decreased depressive symptoms in the early weeks of use, without modifying alcohol use. Valproate efficacy to reduce excessive alcohol consumption in bipolar patients 14 was confirmed 16 and new controlled studies revealed its therapeutic benefit to prevent relapse in newly abstinent alcoholics 17 and to improve alcohol hallucinosis.…”

“…Indeed, since Salloum and colleagues 14 reported that adjunctive valproate reduces excessive alcohol consumption in bipolar patients, the only other randomized study with a clinically important result is that quetiapine therapy was associated with a statistically significant decrease in depressive symptoms, at least in the early weeks of use, but not alcohol use, in patients with bipolar disorder and alcohol dependence. 33 The optimal therapeutic goals of excessive alcohol drinking are alcohol withdrawal coupled with relapse prevention. Well controlled trials in alcoholic patients (mostly without bipolar disease) showed that valproate is of therapeutic benefit in both alcohol withdrawal and relapse prevention.…”

“…In 2008, Brown and colleagues 33 reported the results of a randomized, double-blind, placebo-controlled trial of quetiapine (add-on therapy) in 115 outpatients with bipolar disorder and alcohol abuse or dependence. Patients were randomly assigned to 12 weeks of quetiapine (titrated to 600 mg/day) add-on therapy or placebo.…”

“…The between-group difference was largely due to differences in HRSD scores during the first six weeks of the trial, with the placebo group showing greater improvement during the second half of the trial. 33 Martinotti and colleagues 34 recently conducted an openlabel 16 week study of quetiapine on 28 alcohol-dependent subjects with high levels of mood and behavioral instability, including 16 patients with bipolar disorders. Quetiapine significantly decreased alcohol consumption (43% of patients remained totally alcohol-free for the duration of the study), craving for alcohol, and psychiatric symptoms intensity (HDRS and BPRS), maintaining a good level of tolerability.…”