Icro Maremmani Angelo Giovanni, Bacciardi Silvia, Rovai Luca, Rugani Fabio, Massimetti Enrico, Gazzarrini Denise, Dell'Osso Liliana, Maremmani Icro
Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Pisa 56100, Italy.
Section of Psychiatry, Department of Experimental and Clinical Medicine, University of Pisa, Pisa 56100, Italy.
Int J Environ Res Public Health. 2014 Dec 12;11(12):12983-96. doi: 10.3390/ijerph111212983. Print 2014 Dec.
Glutamate system is modified by ethanol and contributes both to the euphoric and the dysphoric consequences of intoxication, but there is now growing evidence that the glutamatergic system also plays a central role in the neurobiology and treatment of mood disorders, including major depressive disorders and bipolar disorders. We speculate that, using acamprosate, patients with bipolar depression (BIP-A) can take advantage of the anti-glutamate effect of acamprosate to "survive" in treatment longer than peers suffering from non-bipolar depression (NBIP-A) after detoxification.
We retrospectively evaluated the efficacy of a long-term (six-month) acamprosate treatment, after alcohol detoxification, in 41 patients (19 males and 22 females), who could be classified as depressed alcoholics, while taking into account the presence/absence of bipolarity.
During the period of observation most NBIP-A patients relapsed, whereas a majority of BIP-A patients were still in treatment at the end of their period of observation. The cumulative proportion of 'surviving' patients was significantly higher in BIP-A patients, but this finding was not related to gender or to other demographic or clinically investigated characteristics. The treatment time effect was significant in both subgroups. The treatment time-group effect was significant (and significantly better) for bipolar patients on account of changes in the severity of their illness.
Retrospective methodology and the lack of DSM criteria in diagnosing bipolarity.
Bipolarity seems to be correlated with the efficacy of acamprosate treatment in inducing patients to refrain from alcohol use after detoxification (while avoiding relapses) in depressed alcoholics. Placebo-controlled clinical trials are now warranted to check the validity of this hypothesis.
谷氨酸系统会被乙醇改变，这既导致了醉酒后的欣快感，也造成了烦躁不安的后果，但现在越来越多的证据表明，谷氨酸能系统在包括重度抑郁症和双相情感障碍在内的情绪障碍的神经生物学和治疗中也起着核心作用。我们推测，对于双相抑郁症（BIP-A）患者，使用阿坎酸可以利用其抗谷氨酸作用，使其在戒酒排毒后比非双相抑郁症（NBIP-A）患者在治疗中“存活”更长时间。
我们回顾性评估了41例（19例男性和22例女性）可归类为抑郁性酗酒者的患者在酒精排毒后接受阿坎酸长期（六个月）治疗的疗效，同时考虑到双相情感障碍的有无。
在观察期内，大多数NBIP-A患者复发，而大多数BIP-A患者在观察期结束时仍在接受治疗。BIP-A患者中“存活”患者的累积比例明显更高，但这一发现与性别或其他人口统计学或临床研究特征无关。治疗时间效应在两个亚组中均显著。由于病情严重程度的变化，治疗时间-组效应在双相情感障碍患者中显著（且显著更好）。
回顾性研究方法以及在诊断双相情感障碍时缺乏DSM标准。
双相情感障碍似乎与阿坎酸治疗在诱导抑郁性酗酒者戒酒排毒后避免复发方面的疗效相关。现在有必要进行安慰剂对照临床试验来检验这一假设的有效性。
