Efficacy of pharmacotherapeutics for patients comorbid with alcohol use disorders and depressive symptoms—A bayesian network meta‐analysis

Abstract

Alcohol use disorders (AUD), including alcohol abuse and alcohol dependence, are common psychiatric disorders contribute greatly to the burden of society. 1 Alcohol-related diseases are one of the leading risk factors of disability and mortality, causing about 3.3 million deaths around the world and taking account for 5.1% of the global burden of disease according to the report of WHO. 2 Depression is a highly prevalent mental illness and is one of the important causes of premature deaths. About 350 million people around the world suffer from depression and nearly one million of

Depression and/or PTSD Comorbidity Affects Response to Antidepressants in Those With Alcohol Use Disorder

“…In a meta-analysis of 15 head-to-head RCTs comparing SSRIs and SNRIs showed that SNRIs had statistical significance over SSRIs in treating MDD ( 47 ); these studies did not include participants with AUD. In the AUD literature, a recent network meta-analysis of 68 RCTs consisting of 5,890 patients with AUD comparing different classes of antidepressants including SSRIs (e.g., paroxetine, citalopram, escitalopram, fluoxetine, and sertraline), NRIs (e.g., venlafaxine and viloxazine), and tricyclic antidepressants (e.g., desipramine, imipramine, amitriptyline) showed that NRIs demonstrated the best efficacy and were superior to SSRIs in reducing scores of depression scales ( 48 ). However, in that study, desipramine was categorized as a tricyclic antidepressant, which did not show any statistically significant difference in both depression and AUD outcomes when compared to SSRIs (including paroxetine) ( 48 ).…”

Which interventions for alcohol use should be included in a universal healthcare benefit package? An umbrella review of targeted interventions to address harmful drinking and dependence.

“…Of the ve studies on disul ram, three very low qualities found a signi cant effect, for increase in AUD remission rate among people with comorbid depression compared with control (OR 5.00, 95% CI 1.97 to 12.95), acamprosate, antipsychotics, bromocriptine, lithium, naltrexone, and SSRI [74]; abstinence at 12 weeks follow-up (SMD − 0.32, 95% CI − 0.56 to − 0.07) but not for heavy drinking days (SMD − 0.44, 95% CI − 0.94 to 0.06) [96]. Similarly, evidence from was inconclusive for antiepileptics, which showed a signi cant improvement in AUD remission rate among individuals with comorbid depression when compared to control, bromocriptine and lithium in a network meta-analysis of odds ratios, but not when compared to control using standardised mean difference (SMD − 0.70, 95% CI − 2.05 to 0.65) [74], and for varenicline, which showed a signi cant effect for alcohol consumption (SMD − 0.37, 95% CI − 0.66 to − 0.07) but not heavy drinking days (SMD − 0.14, 95% CI − 0.33 to 0.05 [85]. Certainty in the evidence for each of the other pharmacological interventions was rated as very low, due to high risk of bias and imprecision in many studies, resulting from very wide con dence intervals and/or sample sizes less than 100.…”

“…It should be noted that total number of participants for both upentixol and quetiapine was below 100. For antipsychotics as a whole, a network meta-analysis of AUD remission rate among people with comorbid depression found no signi cant effect compared with control (OR 0.97, 95% CI 0.30 to 3.22) and suggested that antipsychotics are inferior to disul ram (OR 0.19, 95% CI 0.04 to 0.9) [74]. However, whilst there was no effect on relapse, another review found a signi cant improvement in ratio of abstinent to drinking days when compared with placebo at 3-12 months follow-up (RR 0.17, 95% CI 0.01 to 0.33) [77].…”

“…Certainty in the evidence for anticonvulsants was downgraded to very low, due to high risk of bias, high heterogeneity in RCTs, low precision, and presence of publication bias.Four studies evaluated antidepressants for AUD, of which three considered individuals with comorbid depression [68,74,94]. No signi cant effect was observed on alcohol abstinence among people with comorbid major depressive disorder for nefazodone compared with placebo (OR 2.18, 95% CI 0.68 to 7.07)[94]; AUD remission rate compared to control among individuals with comorbid depression for mirtazapine (SMD − 0.78, 95% CI -1.69 to 0.13)[74], SARI (OR 1.85, 95% CI 0.62 to 5.66)[74], tricyclic antidepressants (OR 1.65, 95% CI 0.57 to 4.73)[74]; or continuous abstinence when compared with placebo at 84-365 days for citalopram or escitalopram (OR 1.03, 95% CI 0.33 to 3.16), nefazodone (OR 0.57, 95% CI 0.19 to 1.76), tianeptine (OR 1.22, 95% CI 0.58 to 2.57), or tiapride (OR 0.56, 95% CI 0.3 to 1.05)[98]. For NRI, a very low quality meta-analysis found a reduction in AUD remission rate compared to control in individuals with comorbid depression for SMD (-2.44, 95% CI -3.53 to -1.36) but not OR (1.15, 95% CI 0.21 to 6.31)[74].…”

Depressive symptoms in alcohol dependence- a cross-sectional study

“…Clinical trials have reported a higher prevalence of depressive symptoms in patients with alcohol dependence. [1][2] Alcohol abuse and alcohol dependence are common psychiatric illnesses; according to WHO, they are responsible for about 3.3 million deaths worldwide. 3 It is estimated that about 350 million people suffer from depression, and out of these, nearly one million of them commit suicide each year.…”