Pittsburgh Post Gazette - Pittsburgh,PA,USA
University of Pittsburgh researchers have found that an anticonvulsant drug may help reduce alcohol use in people with bipolar disorder. ...
http://www.post-gazette.com/pg/05004/436763.stm

Article:

Anticonvulsant drug found to help bipolar alcoholics

Tuesday, January 04, 2005
By Joe Fahy, Pittsburgh Post-Gazette

University of Pittsburgh researchers have found that an anticonvulsant drug may help reduce alcohol use in people with bipolar disorder.

A study published in this month's issue of the journal Archives of General Psychiatry found that patients with both alcoholism and bipolar disorder who took the drug valproate drank less heavily and less often than people with those disorders who did not take the drug.

If confirmed by other studies, the finding could have a significant impact on treatment and lead to broader use of the drug, local physicians say. Forms of valproate are marketed under several trade names, including Depakote.

More than 2 million U.S. adults, or about 1 percent of the adult population, have bipolar disorder. People with the disorder, also known as manic-depressive illness, often have dramatic mood swings that range from periods of high energy, sleeplessness and euphoria to periods of extreme depression.

They can be prone to suicide and may have hallucinations, thinking they hear or see things that are imaginary. They may also suffer from delusional thinking, such as a belief that they have special powers or wealth.

Nearly two out of three people with the most severe type of the disorder, and about half of those with a milder form, abuse alcohol or other substances, according to the National Institute of Mental Health.

"Patients with bipolar disorder and alcoholism are in a very precarious situation," said Dr. Ihsan Salloum, an associate professor of psychiatry at the University of Pittsburgh School of Medicine and the study's lead author. "They have high disability rates, and ultimately the presence of these two disorders leads to higher death rates."

People with bipolar disorder may turn to alcohol to self-medicate. But alcohol use tends to make the mood swings more frequent, said Dr. Neil Capretto, medical director of Gateway Rehabilitation Center.

Patients with bipolar disorder who abuse substances often have difficulty adhering to treatment regimens, which can contribute to a cycle of worsening health and cognitive functioning and lead to greater use of hospital care and other medical services.

Salloum said the results of the study "show that valproate could be an important element to getting control of this dangerous combination of illnesses."

The 24-week study involved 54 people 18 to 65 with diagnoses of both bipolar disorder and alcoholism. Participants were given either valproate or a placebo, and all continued to receive their standard treatment, usually a combination of the drug lithium and counseling therapy.

Of those taking valproate, 44 percent reported heavy drinking days, defined as five or more drinks a day for men and four or more drinks for women. Sixty-eight percent of the placebo group reported heavy drinking days.

Even on the heavy drinking days, people taking valproate drank less: 5.6 drinks compared to 10.2 in the placebo group. And they had fewer heavy drinking days: 11.3 days compared to 18.4 days in the placebo group.

Researchers believe valproate appears to affect receptors in the brain linked to both alcohol use and withdrawal.

Dr. Patton VanMeter Nickell, a psychiatrist and director of adult psychiatric services at Allegheny General Hospital, said that valproate already is used to treat some forms of bipolar disorder, as well as epilepsy and migraines.

If confirmed by other studies, the findings of the Pitt study could have a significant impact on the treatment of people with both alcoholism and bipolar disorder, he said.

Physicians may be encouraged to use the drug more often in patients with bipolar disorder and alcoholism, Gateway's Capretto said.

The study was funded by the National Institute of Mental Health and the National Institute of Alcohol Abuse and Alcoholism.