DOI: https://doi.org/10.22141/2224-0713.3.105.2019.169922

Mood stabilizers: controversial issues in the treatment of alcohol dependence

I.A. Martsenkovskyi, I.I. Martsenkovska

Abstract


Mental and behavioral disorders due to alcohol use are associated with allostatic neuroplastic changes in glutamatergic and GABAergic neurotransmitter brain systems. These disorders are considered to be basic biological mechanisms for the onset of the acute alcohol withdrawal syndrome and uncontrolled alcohol abuse. The article provides an overview of the results of controlled studies on the use of anti-epileptic drugs (AEDs) in alcohol and psychoactive substance use disorders. Benzodiazepines have long been considered as means of patients’ detoxification. Non-benzodiazepine AEDs, primarily valproates and carbamazepine, have been used in clinical practice as mood stabilizers in alcohol use disorders for the past decade. AEDs are also prescribed for the treatment of alcohol withdrawal syndrome and outpatient treatment of alcohol dependence (inhibition of obsessive and compulsive craving for alcohol, prevention of alcoholic relapses). AEDs can be especially useful in outpatient treatment of mild and moderate symptoms of alcohol withdrawal syndrome, to prevent alcoholic relapses, reduce harmful use of alcohol. Valproates, carbamazepine, gabapentin and pregabalin have the greatest evidence base in the treatment of alcohol dependence. There is limited evidence of levetiracetam and topiramate efficacy. Valproates can improve the clinical phenotype of alcohol dependence. In bipolar disorders complicated by alcohol and/or cannabinoid use, valproates have an advantage over lithium salts and benzodiazepines through better tolerability, greater affinity for affective symptoms, and the ability to reduce the severity of drunkenness. Levetiracetam in alcohol-dependent individuals with comorbid anxiety disorders may reduce alcohol consumption and anxiety levels. Gabapentin and pregabalin are recommended for dysmorphic pain disorders, have a limited abuse potential, a low level of sedation compared to benzodiazepines, and relative safety when consumed with alcohol.

Keywords


non-benzodiazepine antiepileptic drugs; alcohol use disorders; dependence syndrome; alcohol withdrawal syndrome; heavy drinking relapses; valproates; carbamazepine; gabapentin; pregabalin; levetiracetam

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