Bipolar disorder and comorbid alcoholism: prevalence rate and treatment considerations

Authors


  • MAF has received research support from Abbott Laboratories, The American Foundation for Suicide Prevention, GlaxoSmithKline, NIMH, Pfizer Inc., Solvay Pharmaceuticals, The Stanley Medical Research Institute; has been a consultant for Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co., GlaxoSmithKline, Janssen-Cilag, Johnson & Johnson PRD, Novartis, Ortho McNeil, Otsuka Pharmaceuticals, Pfizer Inc., Wyeth; is on the speakers bureau for AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co., Otsuka Pharmaceuticals, Pfizer; and has no financial interest or stock ownership in any companies. IMS has received research support from Abbott Laboratories, Ortho McNeil Pharm, Drug Abuse Sciences, Inc., Alkermese, Inc., Oy Contral Pharma, and Lipha Pharma; is a consultant for Abbott Laboratories, Forest Laboratories, Cephalon, and AstraZeneca and is on the speakers bureau for Abbott Laboratories and Janssen Pharmaceutica.

Mark A Frye, MD, Mayo Mood Clinic and Research Program, Mayo College of Medicine, 200 First Street, SW, Rochester, MN 55905. Fax: +1 507 255 9416; e-mail: mfrye@mayo.edu

Abstract

Classic Kraepelian observations and contemporary epidemiological studies have noted a high prevalence rate between bipolar disorder and alcoholism. The extent to which these two illnesses are comorbid (i.e., two distinct disease processes each with an independent course of illness), genetically linked, or different phenotypic expressions of bipolar illness itself continues to be investigated. It is increasingly clear that co-occurring alcohol abuse or dependence in bipolar disorder phenomenologically changes the illness presentation with higher rates of mixed or dysphoric mania, rapid cycling, increased symptom severity, and higher levels of novelty seeking, suicidality, aggressivity, and impulsivity. It is very encouraging that interest and efforts at evaluating pharmacotherapeutic compounds has substantially increased over the past few years in this difficult-to-treat patient population. This article will review the clinical studies that have evaluated the effectiveness of conventional mood stabilizers (lithium, carbamazepine, divalproex, and atypical antipsychotics) in the treatment of alcohol withdrawal and relapse prevention in patients with alcoholism and in the treatment of bipolar disorder with comorbid alcoholism. A number of add-on, adjunctive medications, such as naltrexone, acamprosate, topiramate, and the atypical antipsychotics quetiapine and clozapine, may be candidates for further testing.

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