Rethinking the Use of Antidepressants to Treat Alcohol Use Disorders and Depression Comorbidity: The Role of Neurogenesis

Abstract

Patients with alcohol use disorders (AUDs) are frequently treated with antidepressant drugs (ADs), but clinical evidence of their efficacy is contradictory. Considering that ADs are thought to produce their therapeutic effects partially by increasing hippocampal plasticity and neurogenesis (HN), and that both AUDs and depression share a potential for the disruption of these neuroplastic processes, one could reasonably wonder whether the poor efficacy of AD treatment could be explained by the inability of these drugs to exert their proper action in patients suffering from AUD or depression. In order to further clarify this question, this chapter aims to examine available data regarding the effect of ADs on behavioral and HN alterations related to alcohol abstinence, as a key period in which the treatment would be implemented and in which their potential effects on alcohol-related problems remain under controversy.

Antidepressants and alcohol use disorder: A multicenter study on the mediating role of depression symptom changes

“…Thereby, the identified dual pathway framework may echo the inconsistent findings in previous research. For instance, some studies have reported that antidepressants may improve AUD treatment outcomes (Chan et al, 2015;Li et al, 2020;McHugh & Weiss, 2019;Ostacher, 2007;Pettinati, 2004), while others have found little or no benefit (Iovieno et al, 2011;Nunes & Levin, 2004;Torrens et al, 2005), or even a negative effect (Ballesta, Alén, et al, 2019;Brookwell et al, 2014;Dundon et al, 2004;Muhonen et al, 2008;Yoon & Petrakis, 2018;Zhou et al, 2015). Our findings might help to reconcile some of these conflicting results by suggesting that the benefits of antidepressants no effect on alcohol-related outcomes (Zhou et al, 2015).…”

“…About half of patients with AUD reporting depression symptoms during withdrawal treatment are prescribed antidepressants, even though it is not necessarily indicated, as they may not respond to antidepressants beyond the remission that is achieved with alcohol abstinence (Ballesta, Orio, et al, 2019). In those cases, the prescription of antidepressants is unnecessary, costly and burdensome to those patients (Pary et al, 2017;Pettinati et al, 2013).…”

“…However, in the absence of significant depression symptoms, studies show heterogeneous results and a trend toward no evidence of antidepressants on AUD symptoms (Iovieno et al, 2011;Nunes & Levin, 2004;Torrens et al, 2005). Importantly, some findings even indicate a negative effect of antidepressants on AUD symptoms, such as provoking premature relapse (Ballesta, Alén, et al, 2019;Brookwell et al, 2014;Dundon et al, 2004).…”

“…Therefore, the aim of the present study is to narrow this gap. Based on previous studies (Alén et al, 2013;Ballesta, Alén, et al, 2019;Brookwell et al, 2014;Dundon et al, 2004;Iovieno et al, 2011;Nunes & Levin, 2004), we assume antidepressants to have an overall positive impact on depression symptoms and alcohol use. We expect a decrease in depression symptoms to be associated with a decrease in alcohol use as well and that the direct effect of antidepressants on alcohol use diminishes when accounting for the change in depression symptoms (Nunes et al, 1998).…”