Sherwood Brown E, McArdle Meagan, Palka Jayme, Bice Collette, Ivleva Elena, Nakamura Alyson, McNutt Markey, Patel Zena, Holmes Traci, Tipton Shane
Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
Eur Neuropsychopharmacol. 2021 Feb;43:92-101. doi: 10.1016/j.euroneuro.2020.12.006. Epub 2021 Jan 2.
Bipolar disorder is associated with high rates of alcohol use disorder. However, little is known about the treatment of this dual diagnosis population. Previous studies suggest that ondansetron decreases alcohol use, particularly in people with specific single nucleotide polymorphism (SNP) alleles. A 12-week, randomized, double-blind, placebo-controlled trial of ondansetron was conducted in 70 outpatients with bipolar spectrum disorders and early onset alcohol use disorder. Outcome measures included alcohol use, assessed with the Timeline Followback method, Penn Alcohol Craving Scale (PACS), Hamilton Rating Scale for Depression (HRSD), Inventory of Depressive Symptomatology-Self-report, and Young Mania Rating Scale. SNPs rs1042173, rs1176713 and rs1150226 were explored as predictors of response. Participants had a mean age of 44.9 ± 9.4 years, were mostly men (60.0%), and African American (51.4%). Mean ondansetron exit dose was 3.23 ± 2.64 mg. No significant between-group differences in alcohol use measures were observed. However, a significant reduction in HRSD scores was observed (p = 0.045). Inclusion of SNPs increased effect sizes for some alcohol-related outcomes and the HRSD. Ondansetron was well tolerated. This proof-of-concept study is the first report on ondansetron in bipolar people with bipolar disorders and alcohol use disorder. Alcohol use did not demonstrate a significant between-group difference. However, the findings suggest that ondansetron may be associated with reduction in depressive symptom severity in persons with bipolar illnesses and alcohol use disorder. A larger trial is needed to examine the effects of ondansetron on bipolar depression.
双相情感障碍与酒精使用障碍的高发病率相关。然而，对于这一双重诊断人群的治疗知之甚少。先前的研究表明，昂丹司琼可减少酒精使用，尤其是在具有特定单核苷酸多态性（SNP）等位基因的人群中。对70名双相谱系障碍和早发性酒精使用障碍的门诊患者进行了一项为期12周的昂丹司琼随机、双盲、安慰剂对照试验。结局指标包括使用时间线追溯法评估的酒精使用情况、宾夕法尼亚酒精渴望量表（PACS）、汉密尔顿抑郁量表（HRSD）、抑郁症状自评量表以及青年躁狂评定量表。探索了SNP rs1042173、rs1176713和rs1150226作为反应预测指标。参与者的平均年龄为44.9±9.4岁，大多数为男性（60.0%），且为非裔美国人（51.4%）。昂丹司琼的平均停药剂量为3.23±2.64毫克。在酒精使用指标方面未观察到显著的组间差异。然而，观察到HRSD评分有显著降低（p = 0.045）。纳入SNP增加了一些与酒精相关结局和HRSD的效应量。昂丹司琼耐受性良好。这项概念验证研究是关于昂丹司琼治疗双相情感障碍和酒精使用障碍患者的首份报告。酒精使用情况未显示出显著的组间差异。然而研究结果表明，昂丹司琼可能与双相情感障碍和酒精使用障碍患者的抑郁症状严重程度降低有关。需要进行更大规模的试验来研究昂丹司琼对双相抑郁的影响。
