Naltrexone in patients with bipolar disorder and alcohol dependence

Brown, E. Sherwood; Beard, Laura; Dobbs, Lauren K.; Rush, A. John

doi:10.1002/da.20213

Cited by 41 publications

(23 citation statements)

References 16 publications

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“…While lithium may also show some benefits (level 3),617 it has to be used with caution in heavy drinkers because of potential electrolyte imbalance; and anticonvulsants warrant liver function tests and lipase levels before initiating treatment. Agents for primary alcohol use disorder may also show benefits in BD, such as disulfiram (level 3),688, 689, 690, 691 naltrexone (level 3)692, 693, 694, 695 and gabapentin (level 4) 696, 697. Furthermore, guidelines for pharmacotherapy in alcohol dependence alone can offer some guidance in the absence of comorbidity‐specific trials 698…”

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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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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“…Well controlled studies are required to further investigate the efficacy of naltrexone, alone or in combination with mood stabilizers, against alcohol use disorders in bipolar patients. 38,39 • Aripiprazole. Aripiprazole seems efficient in reducing alcohol use disorders in alcohol-dependent subjects 48,49 and even in bipolar patients.…”

Section: Discussionmentioning

confidence: 99%

“…37 Drugs specifically used for treating alcohol dependence Naltrexone Naltrexone is effective for alcohol dependence, but its safety and efficacy are not established in patients with bipolar disorder and alcohol dependence. Brown and colleagues 38 recently reported the results of a 16-week, open-label, add-on pilot study of naltrexone conducted in 34 outpatients with bipolar disorder and alcohol dependence. Assessments included the 17-item HRSD, YMRS, BPRS and an alcohol-craving scale.…”

Section: Olanzapinementioning

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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“…For example, no controlled clinical trials of any of the three approved medications for treatment of alcohol dependence have been conducted in bipolar patients, despite the fact that almost one half of all bipolar individuals will develop an AUD at some point in their lives. Brown et al [35] found significantly decreased craving and days of alcohol use in a 16-week, open-label trial of naltrexone in 34 bipolar, alcohol-dependent patients, suggesting that controlled trials of this medication are warranted. Acamprosate, the most recently approved medication for alcohol dependence, is currently being tested in an open-label trial at our site, and preliminary results are encouraging.…”

Section: Bipolar Disordermentioning

confidence: 99%

Treatment of patients comorbid for addiction and other psychiatric disorders

Brady

Verduin²,

Tolliver³

2007

Curr Psychiatry Rep

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Psychiatric disorders and drug and alcohol use disorders commonly co-occur. A growing literature has documented the epidemiology and effects on the course of illness of comorbid psychiatric and substance use disorders (SUDs). Advances in treatment of co-occurring illnesses have progressed more slowly. The current article reviews recent developments in the diagnosis and treatment of co-occurring psychiatric disorders and SUDs with particular focus on psychotic disorders, affective disorders, anxiety disorders, personality disorders, and attention-deficit/hyperactivity disorder. Current treatment options and implications for future research are highlighted.

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Naltrexone in patients with bipolar disorder and alcohol dependence

Cited by 41 publications

References 16 publications

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

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

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

Treatment of patients comorbid for addiction and other psychiatric disorders

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