Guía de práctica clínica para el tratamiento farmacológico y psicológico de los pacientes adultos con trastorno bipolar y un diagnóstico comórbido de trastorno por uso de sustancias

  1. Ana González-Pinto
  2. José Manuel Goikolea
  3. Iñaki Zorrilla
  4. Miquel Bernardo
  5. Manuel Arrojo
  6. Ruth Cunill
  7. Xavi Castell
  8. Elisardo Becoña
  9. Ana López
  10. Marta Torrens
  11. Judit Tirado-Muñoz
  12. Francina Fonseca
  13. Belén Arranz
  14. Marina Garriga
  15. Pilar A. Sáiz
  16. Gerardo Flórez
  17. Luis San
Adicciones: Revista de socidrogalcohol

ISSN: 0214-4840

Datum der Publikation: 2022

Ausgabe: 34

Nummer: 2

Seiten: 142-156

Art: Artikel

Andere Publikationen in: Adicciones: Revista de socidrogalcohol


This review synthesizes the pharmacological and psychosocial interventions that have been conducted in comorbid bipolar disorder (BD) and substance use disorders (SUDs) while also providing clinical recommendations about which intervention elements are helpful for addressing substance use versus mood symptoms in patients with these co-occurring conditions. The best evidence from randomized controlled trials was used to evaluate treatment options. The strength of recommendations was described using the GRADE approach. Very few of the randomized trials performed so far have provided consistent evidence for the management of both mood symptoms and substance use in patients with a BD. No clinical trials are available for bipolar patients using cannabis. Some treatments have shown benefit for mood symptoms without benefits for alcohol or illicit substance use. Our results suggest that 1) we can (weakly) recommend the use of adjuvant valproate or naltrexone to improve symptoms of alcohol use disorder; 2) Lamotrigine add-on therapy seems to reduce cocaine-related symptoms and is therefore recommended (moderate strength); and 3) Varenicline is (weakly) recommended to improve nicotine abstinence. Integrated group therapy is the most-well validated and efficacious approach on substance use outcomes if substance use is targeted in an initial treatment phase.

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