title: Six-month outcome in bipolar spectrum alcoholics treated with acamprosate after detoxification: a retrospective study.
abstract: BACKGROUND
  Glutamate system is modified by ethanol and contributes both to the euphoric and the dysphoric consequences of intoxication, but there is now growing evidence that the glutamatergic system also plays a central role in the neurobiology and treatment of mood disorders, including major depressive disorders and bipolar disorders. We speculate that, using acamprosate, patients with bipolar depression (BIP-A) can take advantage of the anti-glutamate effect of acamprosate to "survive" in treatment longer than peers suffering from non-bipolar depression (NBIP-A) after detoxification.
  
  
  METHODS
  We retrospectively evaluated the efficacy of a long-term (six-month) acamprosate treatment, after alcohol detoxification, in 41 patients (19 males and 22 females), who could be classified as depressed alcoholics, while taking into account the presence/absence of bipolarity.
  
  
  RESULTS
  During the period of observation most NBIP-A patients relapsed, whereas a majority of BIP-A patients were still in treatment at the end of their period of observation. The cumulative proportion of 'surviving' patients was significantly higher in BIP-A patients, but this finding was not related to gender or to other demographic or clinically investigated characteristics. The treatment time effect was significant in both subgroups. The treatment time-group effect was significant (and significantly better) for bipolar patients on account of changes in the severity of their illness.
  
  
  CONCLUSIONS
  Retrospective methodology and the lack of DSM criteria in diagnosing bipolarity.
  
  
  CONCLUSIONS
  Bipolarity seems to be correlated with the efficacy of acamprosate treatment in inducing patients to refrain from alcohol use after detoxification (while avoiding relapses) in depressed alcoholics. Placebo-controlled clinical trials are now warranted to check the validity of this hypothesis.
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Pisa 56100, Italy. angelogimaremmani@gmail.com.
authors.forename: Angelo Giovanni
authors.initials: AG
authors.lastname: Icro Maremmani
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Pisa 56100, Italy. s.baciard@gmail.com.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bacciardi
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Pisa 56100, Italy. lucarovai@yahoo.com.
authors.forename: Luca
authors.initials: L
authors.lastname: Rovai
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Pisa 56100, Italy. fabruga@gmail.com.
authors.forename: Fabio
authors.initials: F
authors.lastname: Rugani
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Pisa 56100, Italy. e.massimetti@yahoo.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Massimetti
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Pisa 56100, Italy. denise.gazzarrini@hotmail.it.
authors.forename: Denise
authors.initials: D
authors.lastname: Gazzarrini
authors.affiliation: Section of Psychiatry, Department of Experimental and Clinical Medicine, University of Pisa, Pisa 56100, Italy. liliana.dellosso@med.unipi.it.
authors.forename: Liliana
authors.initials: L
authors.lastname: Dell'Osso
authors.affiliation: Vincent P. Dole Dual Diagnosis Unit, Department of Neurosciences, Santa Chiara University Hospital, University of Pisa, Pisa 56100, Italy. maremman@med.unipi.it.
authors.forename: Icro
authors.initials: I
authors.lastname: Maremmani
mesh_terms: D000077443:Acamprosate; D000293:Adolescent; D000328:Adult; D000368:Aged; D000427:Alcohol Deterrents / Q000627:therapeutic use*; D000437:Alcoholism / Q000188:drug therapy*; D001714:Bipolar Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013654:Taurine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000427:Alcohol Deterrents; D013654:Taurine; D000077443:Acamprosate