Is combining SSRI with aripiprazole effective in depression plus alcohol dependence?:Jl Psychopharm.March.2013


Depression is often comorbid with alcohol dependence.Dual diagnosis make response to treatment less than desirable.It is suggested that effective treatment of depression might also reduce the severity of alcohol use. Both disorders share some neurobiological features ( Both have problems in reward circuitry.Dopamine is thought to play a crucial role in initiation and reinstatement in addiction.Disrupted striatal dopamine in patients with MDD has been reported to increase the salience of mild negative stimuli .Serotonin synthesis is lowered in alcohol dependence.Serotonin deficits in depression are more established), hence it is thought that a combination of medication with effects on dopamine and serotonin systems might be better. Aripiprazole augmentation of antidepressants has been reported to be effective (Marcus et al., 2008 ,Berman et al. 2009). Aripiprazole is also reported to reduce craving.

Doug Hyun Han, Sun Mi Kim, Jung Eun Choi,Kyung Joon Min and Perry F Renshaw investigated whether augmenting escitalopram with aripiprazole would improve depressive symptoms as well as reduce craving for alcohol and cue-induced brain activity in patients with alcohol dependence compared with treatment with escitalopram alone.

Patients with depression and alcohol dependence ,( BDI more than 19, MAST more than 19).35 patients were randomised.Over a period of 5–10 days, all subjects were detoxified with lorazepam (1–4 mg/day)  and then  started on  either flexible doses of aripiprazole (5-15mg) + escitalopram (10-20mg)or escitalopram only for 6 baseline and at 6 weeks, brain activity in response to alcohol drinking cue presentation was assessed by  fMRI.

Results: There were no significant differences in numbers  responded ( for depression outcome) between the groups. Craving was lesser in combination group.There was no difference in number of people remained alcohol free at the end of 6 weeks between the treatment groups. The activity within the anterior cingulate was increased in response to the presentation of alcohol drinking scenes following treatment in the aripiprazole + escitalopram group.

Conclusions:  Aripiprazole + escitalopram is not  more effective than  escitalopram only treatment in reducing depression or alcohol intake. Dopamine release induced by aripiprazole might be associated with increased activation of the anterior cingulate, which may control craving for alcohol during alcohol-cue stimulation in patients with MDD.

Summary of the article:

Adjunctive aripiprazole therapy with escitalopram in patients with co-morbid major depressive disorder and alcohol dependenceClinical and neuroimaging evidence.Han DH, Kim SM, Choi JE, Min KJ, Renshaw PF. J Psychopharmacol. 2013 Mar;27(3):282-91

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