Efficacy of Valproate Maintenance in Patients With Bipolar Disorder and Alcoholism

Salloum, Ihsan M.; Cornelius, Jack R.; Daley, Dennis C.; Kirisci, Levent; Himmelhoch, Jonathan M.; Thase, Michael E.

doi:10.1001/archpsyc.62.1.37

Cited by 242 publications

(158 citation statements)

References 63 publications

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“…15 recent data In 2007, further evidence for valproate efficacy in reducing excessive alcohol consumption in bipolar patients was provided by Sattar,16 who conducted a 24-week open study in 20 patients with bipolar disorder comorbid with alcohol dependence (n = 10) or other stimulant dependence (n = 10). Similarly to Salloum and colleagues, 14 subjects halved the number of substance use days (17.1 vs 9.7 days) as compared with the month before valproate treatment, 16 although the difference was of borderline statistical significance (P = 0.07). Patients tolerated valproate well with minimal reports of side effects and no liver toxicity was noted.…”

Section: Anticonvulsants Valproate Previous Datasupporting

confidence: 51%

“…In 2005, Salloum and colleagues 14 published the results of a randomized, double blind trial where valproate was added to lithium in 59 alcoholic bipolar I patients. Twelve (44%) of 27 subjects in the valproate group reported heavy drinking days compared with 17 (68%) of 25 in the placebo group.…”

Section: Anticonvulsants Valproate Previous Datamentioning

confidence: 99%

“…Manic and depressive symptoms improved equally in both groups. Based on these observations, [11][12][13][14] the American Psychiatric Association (APA) supported the use of valproate to treat the comorbidity of bipolar disease with alcohol abuse. 15 recent data In 2007, further evidence for valproate efficacy in reducing excessive alcohol consumption in bipolar patients was provided by Sattar,16 who conducted a 24-week open study in 20 patients with bipolar disorder comorbid with alcohol dependence (n = 10) or other stimulant dependence (n = 10).…”

Section: Anticonvulsants Valproate Previous Datamentioning

confidence: 99%

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

Azorin

Bowden²,

Garay

et al. 2010

NDT

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About half of all bipolar patients have an alcohol abuse problem at some point of their lifetime. However, only one randomized, controlled trial of pharmacotherapy (valproate) in this patient population was published as of 2006. Therefore, we reviewed clinical trials in this indication of the last four years (using mood stabilizers, atypical antipsychotics, and other drugs). Priority was given to randomized trials, comparing drugs with placebo or active comparator. Published studies were found through systematic database search (PubMed, Scirus, EMBASE, Cochrane Library, Science Direct). In these last four years, the only randomized, clinically relevant study in bipolar patients with comorbid alcoholism is that of Brown and colleagues (2008) showing that quetiapine therapy decreased depressive symptoms in the early weeks of use, without modifying alcohol use. Several other open-label trials have been generally positive and support the efficacy and tolerability of agents from different classes in this patient population. Valproate efficacy to reduce excessive alcohol consumption in bipolar patients was confirmed and new controlled studies revealed its therapeutic benefit to prevent relapse in newly abstinent alcoholics and to improve alcohol hallucinosis. Topiramate deserves to be investigated in bipolar patients with comorbid alcoholism since this compound effectively improves physical health and quality of life of alcohol-dependent individuals. In conclusion, randomized, controlled research is still needed to provide guidelines for possible use of valproate and other agents in patients with a dual diagnosis of bipolar disorder and substance abuse or dependence.

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Section: Anticonvulsants Valproate Previous Datasupporting

confidence: 51%

Section: Anticonvulsants Valproate Previous Datamentioning

confidence: 99%

Section: Anticonvulsants Valproate Previous Datamentioning

confidence: 99%

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

Azorin

Bowden²,

Garay

et al. 2010

NDT

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“…A combination of divalproex and lithium is the only treatment for alcohol use disorder comorbid with BD that meets criteria for level 2 evidence 682, 683. In a small RCT, there was a significant reduction in the number of drinks per drinking day, as well as per heavy drinking day, in the combination group compared to the group with lithium alone when adherence to treatment was added as a covariate.…”

Section: Specific Populationsmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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“…Segundo Salloum et al (2005), o valproato de sódio foi efetivo no tratamento de uma amostra de 59 indivíduos com SDA associada a transtorno bipolar tipo I ao reduzir os dias de consumo pesado de álcool e os níveis séricos de GGT.…”

Section: Valproato De Sódiounclassified

Uso potencial dos anticonvulsivantes no tratamento ambulatorial da dependência de álcool

Castro

Couzi

2006

J. bras. psiquiatr.

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ResumoAtualmente três medicações (dissulfiram, naltrexona e acamprosato) são aprovadas pela Food and Drug Administration (FDA) para tratar a dependência de álcool. As drogas anticonvulsivantes clássicas são raramente empregadas como alternativa por causa dos seus efeitos colaterais, mas a sua última geração pode ser útil. Os anticonvulsivantes podem ser uma alternativa aos benzodiazepínicos (BZD) e a outros tratamentos farmacoló-gicos na prevenção de complicações na desintoxicação por apresentarem ausência de propriedades aditivas e um melhor perfil de efeitos adversos do que os anticonvulsivantes clássicos. Anticonvulsivantes como carbamazepina, ácido valpróico, gabapentina e topiramato demonstraram-se excelentes tratamentos para síndrome de abstinência do álcool e prevenção de recaídas. Embora nenhum desses agentes tenha sido aprovado pela FDA, existe uma crescente evidência na literatura que apóia o seu uso. Palavras-chave: anticonvulsivantes, alcoolismo, carbamazepina, ácido valpróico. AbstractCurrently three medications (disulfiram, naltrexone and acamprosate) are approved by the FDA to treat alcohol dependence by the FDA. The classical anticonvulsive drugs are rarely employed as an alternative because of their side effects, but the latest generation of anticonvulsants could be useful. The anticonvulsants can be a alternative to BZD and other pharmacological treatments in the prevention of complications during the detoxification therapy, because of the absence of addictive properties and a better adverse effects profile than classical anticonvulsant drugs. Anticonvulsants such as carbamazepine, valproic acid, gabapentin and topiramate have shown to be excellent treatment for alcohol withdrawal and for the prevention of alcohol relapse. Although none of these agents have been approved by the FDA yet, there is growing evidence in the literature to support their use.

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Efficacy of Valproate Maintenance in Patients With Bipolar Disorder and Alcoholism

Abstract: Valproate therapy decreases heavy drinking in patients with comorbid bipolar disorder and alcohol dependence. The results of this study indicate the potential clinical utility of the anticonvulsant mood stabilizer, valproate, in bipolar disorder with co-occurring alcohol dependence.

Cited by 242 publications

References 63 publications

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

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

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Uso potencial dos anticonvulsivantes no tratamento ambulatorial da dependência de álcool

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