Psychiatrie Schwäbisch Hall, Schwäbisch Hall, Germany.
Paracelsus Medical University, Nuremberg, Germany.
Expert Opin Pharmacother. 2022 Jul;23(10):1181-1193. doi: 10.1080/14656566.2022.2083500. Epub 2022 Jun 3.
Comorbidity of bipolar disorder (BD) and alcohol use disorder (AUD) is very frequent resulting in detrimental outcomes, including increased mortality. Diagnosis of AUD in BD and vice versa is often delayed as symptoms of one disorder mimic and obscure the other one. Evidence for pharmacotherapies for people with comorbid BD and AUD remains limited, and further proof-of-concept studies are urgently needed.
This paper explores the currently available pharmacotherapies for AUD, BD and their usefulness for comorbid BD and AUD. It also covers to some degree the epidemiology, diagnosis, and potential common neurobiological traits of comorbid BD and AUD.
The authors conclude that more controlled studies are needed before evidence-based guidance can be drawn up for clinician's use. Since there are no relevant pharmacological interactions, approved medications for AUD can also be used safely in BD. For mood stabilization, lithium should be considered first in adherent persons with BD and comorbid AUD. Alternatives include valproate, lamotrigine, and some atypical antipsychotics, with partial D2/D3 receptor agonism possibly being beneficial in AUD, too.
双相情感障碍（BD）和酒精使用障碍（AUD）共病非常常见，导致不良后果，包括死亡率增加。BD 和 AUD 的诊断通常会被延迟，因为一种疾病的症状会模仿和掩盖另一种疾病的症状。对于共患 BD 和 AUD 的人的药物治疗证据仍然有限，迫切需要进一步的概念验证研究。
本文探讨了目前用于 AUD、BD 的药物治疗方法，以及它们在共患 BD 和 AUD 中的用途。它还在一定程度上涵盖了共患 BD 和 AUD 的流行病学、诊断和潜在的共同神经生物学特征。
作者得出结论，需要进行更多的对照研究，才能为临床医生的使用制定出基于证据的指导方针。由于没有相关的药物相互作用，因此 AUD 的批准药物也可以在 BD 中安全使用。对于情绪稳定，对于依从性好的 BD 合并 AUD 患者，首先应考虑使用锂。替代药物包括丙戊酸盐、拉莫三嗪和一些非典型抗精神病药，D2/D3 受体部分激动剂可能对 AUD 也有好处。
