Medications for Alcohol Use Disorders: An Overview

It would be beneficial to know precisely under what conditions antidepressant therapy would yield optimal outcomes for treating comorbid depression and alcohol dependence. There are real concerns about medication interactions with alcohol in patients who were still drinking. Also, depressive symptoms can be brought on by excessive alcohol use, which makes it difficult to separate a substance-induced depression from an independent disorder of clinical depression. Traditionally, placing patients in 28-day inpatient settings, which helped patients abstain from alcohol, easily permitted an independent depressive disorder to be identified and treated. This practice is much less of an option in today’s US health care environment, and this has challenged us to rethink our clinical management of these patients.

Prevalence of depressive disorders and AUD

Among people in treatment for DSM-IV AUD, almost 33% met criteria for major depressive disorder in the past year, and 11% met criteria for dysthymia. However, major depressive disorder is the most common co-occurring disorder among people who have AUD, partly because it is among the most common disorders in the general population. In another study, NAc glycine modulates basal and ethanol-induced dopamine levels in the NAc as well as voluntary ethanol consumption. The same group developed another inhibitor Org which also reduced ethanol intake when it was compared with acamprosate (Lido et al., 2012). Overall, both Org and Org promoted a robust and long-lasting reduction in voluntary alcohol consumption and reversed compulsive relapse-like does drinking make your depression worse alcohol drinking (Molander et al., 2007; Vengeliene et al., 2010).

Clinical Guidelines Analysis

We assessed transitivity (similar distribution of potential effect modifiers across studies) by systematically tabulating and examining characteristics across trials 32. Overall, we considered identified interventions to be comparable, as they are used in specialty care clinical settings as acute treatment for patients with comorbid alcohol use and depressive disorders 7,8. The only major difference across trials that concerned us regarding the transitivity assumption of NMA involved the length of treatment, which ranged from 3 to 26 weeks. We consequently tabulated and compared length of treatment across intervention arms in each network (available in S2 Appendix), and we downgraded confidence in network estimates in which we judged the risk of intransitivity to be high as a result of considerable differences in treatment lengths.

Treatment Results—General Observations

Other agonists of PPARα are oleoylethanolamide (OEA), palmitoylethanolamide (PEA), clofibrate, gemfibrozil; WY14643, and MK886 as an antagonist reported to decrease voluntary ethanol consumption (Le Foll et al., 2014). On the other hand, PPARγ agonists such as pioglitazone, rosiglitazone and ciglitazone are known to reduce voluntary alcohol drinking (Le Foll et al., 2014). Reinforcing and motivational effects of ethanol were studied by using various doses of fenofibrate (Haile & Kosten, 2017).

• The Substance Abuse and Mental Health Services Administration recommends that physicians offer pharmacotherapy with behavioral interventions for patients diagnosed with alcohol use disorder.
• 2019 research suggests that depressive disorders are more common in people with alcohol dependence than in those who engage in alcohol misuse, like binge drinking.
• Despite the limitation of the small sample size, this study showing a reduction in sleepiness and less alcohol craving warrants a replicate study with a larger sample group (Stock et al., 2013).
• Major depression and alcohol use disorder are also co-dependent in women, research suggests.
• In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

So these medications should be used very carefully in the alcohol-dependent patients. Despite the availability of several evidence-based medications and behavioral therapy approaches for treating co-occurring AUD and depressive disorders, improvements in treatment for this population are clearly needed. Consideration of disorder heterogeneity and key subgroup differences may help develop more targeted and personalized treatments to improve outcomes for this population. Many randomized trials have investigated treatments for co-occurring AUD and depressive disorders. In this section, trials that used medication and psychotherapy treatments are discussed, as are the effects of those treatments on depressive symptoms and AUD symptoms. Previously the effects of nalmefene and other opioid agonist were evaluated in male Wistar rats that self-administer ethanol in standard operant conditioning method or exposed to 4-week intermittent ethanol vapor exposure for 14 hours per day for 4 weeks.

Alcohol and other drug use

Below is a description of the most relevant findings, based on the content analysis of comorbid AUD–AnxD treatment (Table 2). We used the recommendations suggested by the Center of Evidence-Based Medicine of Oxford (46), to establish levels of evidence and make recommendations based on the RCT identified. The main clinical guidelines were reviewed in a parallel analysis to contrast the evidence and degrees of scientific recommendations. In a second stage, a search combining the results obtained in the previous searches was performed, aiming at identified articles that contained at least one term from each of the three identified groups (anxiety, alcohol, and psychotropic drugs). After identifying 5,452 citations for review, we excluded 4,758 citations during title and abstract screening, yielding 694 citations for full-text eligibility assessment. We excluded 596 citations at this stage, 16 citations related to ongoing studies or those awaiting a final assessment.

• Several medications and behavioral treatments can help with both depression and AUD.
• A higher dosage of ondansetron (16 μg/kg twice a day) combined with cognitive behavior therapy decreased depression, anxiety, and hostility (Johnson et al., 2003).
• However, only few studies have examined the role of OTRs in mediating the neuropeptide’s effects on motivational actions of alcohol.
• In this review, we have systematically reviewed the recent findings that described the properties of drugs that have been used, currently are in use and the new drug candidates that are repurposed for the treatment of AUDs.
• For example, the criterion of legal problems related to alcohol was removed, and the criterion of alcohol craving was added.