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FOCUS, VOL. 5, No. 2

CLINICAL SYNTHESIS | April 01, 2007

Ask the Expert: Treatment Strategy for Co-occurring Bipolar Disorder and Alcohol Abuse

Marcia L. Verduin, M.D.

FOCUS 2007;5:170-171.

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CME Disclosure

Marcia L. Verduin, M.D., Assistant Professor of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Institute of Psychiatry.

Research Support: Bristol Myers Squibb, Eli Lilly, NIDA, Office of Research on Women's Health.

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What is the best treatment strategy for a patient with both bipolar disorder and alcohol abuse?

In treating individuals with bipolar disorder, this question is extremely important to consider. Nearly 50% of individuals with bipolar disorder have problematic alcohol use (1). Further, alcohol use complicates the course and prognosis of bipolar disorder, leading to higher rates of mixed mania, rapid cycling, suicidality, and increased symptom severity (2). Despite the fact that alcohol use affects nearly half of all individuals with bipolar disorder, with a significant impact on their illness, there are limited data to guide treatment of this comorbidity.

To complicate matters further, there is no simple algorithm for treating these individuals. Psychiatrists must often forge into uncharted clinical territory: either the limited data that do exist to guide treatment decisions are not applicable because of severe medical complications of this comorbidity (e.g., cirrhosis) or only anecdotal evidence is available to support treatment decisions in this population (e.g., alcohol pharmacotherapy).

I recommend the following approach, addressing the most pressing clinical issues first and then systematically addressing other areas of the comorbidity. The choice of pharmacotherapy will depend on the individual's constellation of symptoms and associated medical conditions.

References

Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, Goodwin FK: Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiological Catchment Area (ECA) study. JAMA 1990; 264: 2511— 2518
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Frye MA, Salloum IM: Bipolar disorder and comorbid alcoholism: prevalence rate and treatment considerations. Bipolar Disord 2006; 8: 677— 685
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Salloum IM, Cornelius JR, Daley DC, Kirisci L, Himmelhoch JM, Thase ME: Efficacy of valproate maintenance in patients with bipolar disorder and alcoholism. Arch Gen Psychiatry 2005; 62: 37— 45
[PubMed][CrossRef]

Bowden CL: Lamotrigine in the treatment of bipolar disorder. Expert Opin Pharmacother 2002; 3: 1513— 1519
[PubMed][CrossRef]

Verduin ML, Tolliver BT, Brady KT. Substance abuse and bipolar disorder. 2005; http://www.medscape.com/viewarticle/515954.

Petrakis IL, Nich C, Ralevski E: Psychotic spectrum disorders and alcohol abuse: a review of pharmacotherapeutic strategies and a report on the effectiveness of naltrexone and disulfiram. Schizophr Bull 2006; 32: 644— 654
[PubMed]

Frye MA, Salloum IM: Bipolar disorder and comorbid alcoholism: prevalence rate and treatment considerations. Bipolar Disord 2006; 8: 677— 685
[PubMed][CrossRef]

Bowden CL: Lamotrigine in the treatment of bipolar disorder. Expert Opin Pharmacother 2002; 3: 1513— 1519
[PubMed][CrossRef]

Verduin ML, Tolliver BT, Brady KT. Substance abuse and bipolar disorder. 2005; http://www.medscape.com/viewarticle/515954.

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Marcia L. Verduin; Ask the Expert: Treatment Strategy for Co-occurring Bipolar Disorder and Alcohol Abuse. FOCUS: The Journal of Lifelong Learning in Psychiatry. 2007 Apr;5(2):170-171.

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