Journal
EXPERT OPINION ON PHARMACOTHERAPY
Volume 23, Issue 10, Pages 1181-1193Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/14656566.2022.2083500
Keywords
Alcohol use disorder; bipolar disorder; comorbidity; dual disorder; epidemiology; pharmacotherapy; substance use disorder
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This paper explores the available pharmacotherapies for AUD, BD, and their potential utility in comorbid BD and AUD. It also touches on the epidemiology, diagnosis, and common neurobiological traits of comorbid BD and AUD to some extent.
Introduction 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. Areas covered 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. Expert opinion 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.
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