Drinking on antipsychotics
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Drinking on Antipsychotics: A Comprehensive Review
Introduction to Antipsychotics and Alcohol Dependence
Antipsychotic medications are primarily used to manage psychosis, including schizophrenia and bipolar disorder. However, their use in treating alcohol dependence has been explored with varying results. This article synthesizes research findings on the effects of antipsychotics on alcohol consumption, dependence, and related outcomes.
Efficacy of Antipsychotics in Alcohol Dependence
Systematic Reviews and Meta-Analyses
A systematic review and meta-analysis assessed the utility of antipsychotics in patients with primary alcohol dependence. The study included 13 double-blind, placebo-controlled trials with 1,593 patients. The findings indicated that antipsychotics did not outperform placebo in preventing relapse, reducing heavy drinking days, or decreasing cravings. Additionally, antipsychotics were associated with higher rates of all-cause discontinuation compared to placebo, particularly with aripiprazole and flupenthixol decanoate.
Quetiapine in Heavy Drinkers
A double-blind, placebo-controlled trial evaluated the efficacy of quetiapine in very heavy-drinking alcohol-dependent patients. The study involved 224 participants and found no significant differences between quetiapine and placebo in reducing heavy drinking days or other drinking outcomes. However, quetiapine did reduce depressive symptoms and improve sleep quality. Adverse events such as dizziness, dry mouth, and sedation were more common with quetiapine.
Antipsychotics for Anxiety and Depressive Symptoms in Alcohol Dependence
A systematic review examined the efficacy of anticonvulsants and antipsychotics in treating anxiety and depressive symptoms in alcohol-dependent adults. The review included 23 studies with 2,823 participants. The results were mixed, but the majority of high-quality trials indicated that antipsychotics were not superior to placebo in moderating anxiety and depressive symptoms. Despite being well-tolerated, antipsychotics did not show significant benefits in this context.
Antipsychotics in Schizophrenia with Co-occurring Alcohol Use Disorder
Long-acting Injectable vs. Oral Risperidone
A randomized trial compared long-acting injectable (LAI) risperidone to oral risperidone in patients with schizophrenia and alcohol use disorder. The study found that LAI risperidone might be more effective in reducing the number of drinking days per week compared to the oral form, although both groups continued to drink some alcohol. The lower plasma concentrations of the active metabolite in the LAI group, along with better adherence, may explain these findings.
Course of Psychosis in Schizophrenia with Alcohol Use Disorder
A post hoc analysis of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study revealed that patients with schizophrenia and a history of alcohol use disorder had a shorter time to first exacerbation and hospitalization compared to those without alcohol use disorder. Olanzapine was associated with a longer time to first and recurrent exacerbations compared to other antipsychotics like perphenazine, quetiapine, risperidone, and ziprasidone.
Antipsychotic Use in Alcohol-Related Dementia
A nationwide register study in Finland examined the use of antipsychotics in patients with Wernicke–Korsakoff syndrome (WKS) or alcohol-related dementia (ARD). The study found that antipsychotic use was common and associated with lower mortality compared to non-users. This lower mortality could be attributed to decreased alcohol use and better healthcare coverage among antipsychotic users.
Conclusion
The use of antipsychotics in alcohol dependence and related disorders presents a complex picture. While antipsychotics do not significantly reduce alcohol consumption or cravings, they may offer benefits in specific contexts, such as reducing depressive symptoms or improving adherence in schizophrenia patients. However, the potential for adverse effects and the lack of significant efficacy in reducing alcohol use highlight the need for further research to identify more effective treatments for alcohol dependence.
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