Pharmacotherapy Options in Comorbid Bipolar Disorder and Alcohol-Substance Use Disorders

Abstract

Epidemiological studies have reported that alcoholsubstance use disorders are the most common co-occuring axis I disorder among patients with bipolar disorders. Comorbidity of alcohol-substance use disorders mostly worsens the course of illness in bipolar patients and underlying mechanisms of the association between both disorders still remain unclear. However, the prospective links observed between bipolar disorders and alcohol-substance use disorders support clinical interventions that incorporate both disorders in developing treatment strategies. Here we review the pharmacological treatment choices for alcohol-substance use disorders accompanying bipolar disorders, despite a limited number of treatment studies. The first-line (evidence-based) and secondline (expert opinion) pharmacological agents of bipolar disorder with comorbid alcohol-substance use disorders are quetiapine, lithium or valproate for the depressive phase; valproate or quetiapine for the manic/mixed phase, and valproate monotherapy or a combination of valproate with naltrexone or disulfiram for maintenance. Future prospective studies are required for improvement of treatments in comorbid bipolar and alcohol-substance use disorders.