No debemos olvidar que parte de nuestra formación como integristas es también el area de los transtornos depresivos y de ansiedad,así como el manejo integrado de las adicciones desde la prevención hasta la rehabilitación;es por ello que el día de hoy he querido proponer un artículo que plantea la posibilidad de manejar a pacientes alcóholicos y que además sufren de un transtorno depresivo mayor con memantina y escitalopram.
Insisto en la importancia de la crítica a los estudios,no siempre el artículo expuesto aquí será el más apropiado,y seguramente generará polémica,es parte del propósito de este espacio el que se establezca un sistema de intercambio de opiniones,de crítica constructiva a los estudios y que de aquí se generen proyectos nuevos de investigación,recordemos que es nuestra labor como médicos y más aún como integristas generar mayor fuente de conocimientos,basados siempre en la evidencia,en el análisis de estudios y por supuesto en la continua formación y preparación.
Anexo como ya es costumbre el resúmen en la lengua original,pueden descargar el artículo en:http://www.substanceabusepolicy.com/content/3/1/20
Espacio en el Foro para la discusión del artículo:http://www.medicinaintegrada.org.mx/foros/topic.php?id=28#post-94
Bibliografía:Muhonen L,Lahti J,Sinclair D,Lonnqvist J,Alho H. Treatment of alcohol dependence in patients with co-morbid major depressive disorder –predictors for the outcomes with memantine and escitalopram medication. Substance Abuse Treatment,Prevention,and Policy. 2008;3(1):20.
Treatment of alcohol dependence in patients with co-morbid major depressive disorder –predictors for the outcomes with memantine and escitalopram medication
Background
Alcohol dependence comorbid with major depressive disorder poses a major challenge in the clinical setting. The results in the treatment with selective serotonin re-uptake inhibitors have been conflicting. Thus,we compared in alcohol-dependent patients with co-morbid major depressive disorder the selective serotonin re-uptake inhibitor escitalopram to a compound that acts on different transporter system and may reduce craving,the glutamate receptor antagonist memantine.
Methods
Eighty alcohol-dependent patients comorbid with major depressive disorder in municipal alcohol clinics were randomized 1:1 to receive memantine 20 mg or escitalopram 20 mg in a double-blind manner. During the 26-week study period patients continued their routine treatment at the clinics. Abstinence was not required but encouraged. The patients attended visits weekly during the first month,and then at 3 and at 6 months. Outcome measures were Alcohol Use Disorders Identification Test (AUDIT),Obsessive Compulsive Drinking Scale (OCDS) and Drinking Diary.
Results
The completion rate was high in both groups,especially among the patients who had been abstinent at the beginning of the study. However,among those patients who were not abstinent at baseline,47% in both groups discontinued the study. Numbers of abstinent days were high in both groups throughout the study. In the second half of the study,significantly more abstinent days were found in the memantine group. Alcohol consumption measured by the AUDIT QF (quantity-frequency) score was significantly reduced in both groups,as was the craving for alcohol measured by the OCDS. Lower OCDS scores were observed with memantine,reaching significance at the one month measure. Early age at first alcohol intoxication predicted poor treatment outcomes in patients treated with escitalopram,and the same was seen with the early onset of the first depressive episode. The same predictive effects were not found in patients treated with memantine.
Conclusions
Our results indicate that both memantine and escitalopram are useful adjunct medications for the treatment of alcohol dependence co-morbid with major depression. Memantine was at least as effective with regard to drinking as escitalopram. We believe that a direct comparison of memantine,with the commonly used escitalopram,can provide useful information for clinicians on the treatment of alcohol dependency co-morbid with MDD.
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