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Int. J. Environ. Res. Public Health 2014, 11(12), 12983-12996; doi:10.3390/ijerph111212983

Six-Month Outcome in Bipolar Spectrum Alcoholics Treated with Acamprosate after Detoxification: A Retrospective Study

Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Pisa 56100, Italy
Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca 55045, Italy
Section of Psychiatry, Department of Experimental and Clinical Medicine, University of Pisa, Pisa 56100, Italy
De Lisio Institute of Behavioural Sciences, Pisa 56100, Italy
Author to whom correspondence should be addressed.
Received: 8 August 2014 / Revised: 25 November 2014 / Accepted: 5 December 2014 / Published: 12 December 2014
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Background: Glutamate system is modified by ethanol and contributes both to the euphoric and the dysphoric consequences of intoxication, but there is now growing evidence that the glutamatergic system also plays a central role in the neurobiology and treatment of mood disorders, including major depressive disorders and bipolar disorders. We speculate that, using acamprosate, patients with bipolar depression (BIP-A) can take advantage of the anti-glutamate effect of acamprosate to “survive” in treatment longer than peers suffering from non-bipolar depression (NBIP-A) after detoxification. Method: We retrospectively evaluated the efficacy of a long-term (six-month) acamprosate treatment, after alcohol detoxification, in 41 patients (19 males and 22 females), who could be classified as depressed alcoholics, while taking into account the presence/absence of bipolarity. Results: During the period of observation most NBIP-A patients relapsed, whereas a majority of BIP-A patients were still in treatment at the end of their period of observation. The cumulative proportion of ‘surviving’ patients was significantly higher in BIP-A patients, but this finding was not related to gender or to other demographic or clinically investigated characteristics. The treatment time effect was significant in both subgroups. The treatment time-group effect was significant (and significantly better) for bipolar patients on account of changes in the severity of their illness. Limitations: Retrospective methodology and the lack of DSM criteria in diagnosing bipolarity. Conclusions: Bipolarity seems to be correlated with the efficacy of acamprosate treatment in inducing patients to refrain from alcohol use after detoxification (while avoiding relapses) in depressed alcoholics. Placebo-controlled clinical trials are now warranted to check the validity of this hypothesis. View Full-Text
Keywords: acamprosate; depression; bipolarity; long-term outcome; glutamate acamprosate; depression; bipolarity; long-term outcome; glutamate
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Icro Maremmani, A.G.; Bacciardi, S.; Rovai, L.; Rugani, F.; Massimetti, E.; Gazzarrini, D.; Dell'Osso, L.; Maremmani, I. Six-Month Outcome in Bipolar Spectrum Alcoholics Treated with Acamprosate after Detoxification: A Retrospective Study. Int. J. Environ. Res. Public Health 2014, 11, 12983-12996.

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