Department of Psychiatry, Chung Ang University Hospital, Seoul, Republic of Korea.
J Psychopharmacol. 2013 Mar;27(3):282-91. doi: 10.1177/0269881112472563. Epub 2013 Jan 16.
The effective treatment of depression has been reported to reduce the severity of alcohol use, potentially reflecting improvements in common brain reward circuits. We hypothesized that augmentation therapy of escitalopram with aripiprazole would improve depressive symptoms as well as reduce craving for alcohol and cue-induced brain activity in patients with co-morbid alcohol dependence and major depressive disorder, compared with treatment with escitalopram alone. Thirty-five subjects with major depressive disorder and alcohol dependence were recruited and randomly assigned into 17 aripiprazole + escitalopram and 18 escitalopram only groups. At baseline and following six weeks of treatment, symptoms of depression, craving for alcohol and brain activity were evaluated. During the six week treatment period, Beck Depression Inventory and clinical global index-severity (CGI-S) scores decreased in both the aripiprazole + escitalopram and escitalopram only groups. In addition, following the treatment period, the Korean alcohol urge questionnaire scores in the aripiprazole + escitalopram group were reduced from 23.3±8.4 to 14.3±4.9, compared with those of the escitalopram group of from 21.6±8.4 to 19.3±7.1 (F=13.1, p<0.01). The activity within the anterior cingulate was increased in response to the presentation of alcohol drinking scenes following treatment in the aripiprazole + escitalopram group. The change of brain activity within the left anterior cingulate gyrus in all patients with co-morbid alcohol dependence and major depressive disorder was negatively correlated with the change in craving for alcohol. These findings suggest that the effects of aripiprazole on anterior cingulate cortex might mediate the successful treatment of alcohol dependence in patients with major depressive disorder.
抗抑郁治疗的有效性已被报道可降低酒精使用的严重程度，这可能反映了共同的大脑奖励回路的改善。我们假设与单独使用艾司西酞普兰相比，阿立哌唑增强艾司西酞普兰的治疗将改善共病酒精依赖和重度抑郁症患者的抑郁症状，以及减少对酒精的渴望和线索诱导的大脑活动。招募了 35 名患有重度抑郁症和酒精依赖的受试者，并将其随机分配到阿立哌唑+艾司西酞普兰组和艾司西酞普兰组 18 组。在基线和治疗 6 周后，评估了抑郁症状、对酒精的渴望和大脑活动。在 6 周的治疗期间，阿立哌唑+艾司西酞普兰组和艾司西酞普兰组的贝克抑郁量表和临床总体印象严重程度评分均降低。此外，在治疗期间，阿立哌唑+艾司西酞普兰组的韩国酒精欲望问卷评分从 23.3±8.4 降至 14.3±4.9，而艾司西酞普兰组从 21.6±8.4 降至 19.3±7.1（F=13.1，p<0.01）。在阿立哌唑+艾司西酞普兰组中，对饮酒场景呈现的反应中，前扣带皮层的活动增加。在共病酒精依赖和重度抑郁症患者中，所有患者的左前扣带回脑区活动的变化与对酒精的渴望变化呈负相关。这些发现表明，阿立哌唑对前扣带皮层的作用可能介导了重度抑郁症患者酒精依赖的成功治疗。
