Posted by SalArmy4me on August 28, 2001, at 21:18:08
In reply to Re: Depakote personal experience requested..., posted by Krazy Kat on August 28, 2001, at 13:02:50
Sonne, Susan C. PharmD. Naltrexone for Individuals With Comorbid Bipolar Disorder and Alcohol Dependence. Journal of Clinical Psychopharmacology. 20(1):114-115, February 2000:
"It is well-known that bipolar disorder and substance abuse commonly occur together. However, there is little guidance in the literature concerning the concurrent treatment of these disorders. Naltrexone is a Food and Drug Administration-approved agent for treating alcoholism; however, the studies evaluating its use were done in individuals without psychiatric comorbidity. The following cases describe our experience with naltrexone in two patients with bipolar disorder.
Patient 1
Ms. A, a 30-year-old woman, had a long-standing history of bipolar disorder and alcohol dependence. She also had a history of becoming irritable and aggressive when manic; alcohol intoxication also often led to aggressive behavior, for which she had been arrested. Ms. A had been doing well for approximately 3 months while receiving divalproex 2,000 mg/day and lithium 600 mg/day, but then she started feeling hypomanic with a decreased need for sleep, she communicated with loud, pressured speech, and she reported feeling "jazzed-up." Because she often started drinking when she felt like this, which worsened her behavioral disinhibition, she requested a medication to decrease her desire for alcohol. Her urine drug screen was negative.Ms. A was prescribed naltrexone at 12.5 mg/day for 2 days, increasing to 50 mg/day over the next several days. After the first 12.5-mg dose, Ms. A called to report side effects of nausea, tremor, dysphoria, diaphoresis, and muscle aches. These symptoms dissipated over the next 18 to 24 hours. She refused to take another dose.
Patient 2
Ms. B, a 32-year-old woman, also had a long-standing history of bipolar disorder and alcohol dependence. She had been receiving divalproex 1,500 mg/day for bipolar disorder for approximately 9 months, but she was beginning to feel irritable and reported sleep disturbance, intermittent crying spells, and racing thoughts. She was drinking approximately a bottle of wine per day, which she had not been willing to stop. After much discussion that the alcohol could be contributing to her affective symptoms, she consented to trying naltrexone to decrease her urge to drink.Ms. B was not known to be an opiate abuser, and she denied taking any type of opiate medication. Naltrexone 12.5 mg/day was initiated. She reported side effects after the first dose, including severe nausea with vomiting and piloerection. She refused to take another dose.
Discussion
Naltrexone is generally well tolerated in the alcoholic population, so the severe side effects and medication discontinuation reported by these two women are unusual. There are several possible explanations for the adverse effects they experienced. The symptoms reported by both women are consistent with symptoms of opiate withdrawal. Both women were hypomanic at the time of the first dosing. Mania may be an affective state associated with the production of more endogenous opiates,1 which would make individuals in this state exquisitely sensitive to the actions of an opiate antagonist. There are some data to support that women are more sensitive to the opioid-withdrawal side effects associated with naltrexone.2 It is also possible there is an interaction between divalproex and naltrexone. These two cases suggest that caution should be exercised when prescribing naltrexone to the bipolar individual, particularly during mania or hypomania."-------------------------------------------------
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