Craving and Priming of alcohol in depressive disorders. Bibliographic review and new therapies.

Abstract

Acute alcohol consumption produces positive reinforcement effects, through activation of brain reward circuit, includes limbic system structures (accumbens system and hippocampus). The comorbidity of depressive episode and alcohol abuse makes it necessary to propose new strategies for the treatment of this frequent clinical situation. We conducted a literature review of the combined treatments for major depressive disorder (MDD) with alcohol abuse. We review current literature on the use of new treatments in alcohol consumption with pattern of abuse (binge drinking). Recent studies support the potential clinical importance of NMDA receptor antagonism among the mechanisms underlying the subjective effects of ethanol in humans. The efficacy of medications for alcohol dependence remains modest, and there are no strong clinical predictors of treatment response. We analyze approved medications used today: Acamprosate (NMDA modulator), disulfiram (acetaldehyde dehydrogenase inhibitor), naltrexone (opioid antagonist), nalmefene (opioid antagonist). Promising current studies suggest the glutamatergic pathway and medications such as ketamine could have a hopeful future in the treatment of alcohol use disorder associated with affective disorders.