Случай злоупотребления кока-колой в рамках депрессии

BACKGROUND: Cola is an extremely popular caffeinated soft drink. The media have recently cited a poll in which 16% of the respondents considered themselves to be addicted to cola soft drinks. We find the contrast between the apparent prevalence of cola addiction and the lack of scientific literature on the subject remarkable. To our knowledge, this is the first case of cola dependency described in the scientific literature.
CASE PRESENTATION:
The patient is a 40-year-old woman, who when feeling down used cola to give her an energy boost and feel better about herself. During the past seven years her symptoms increased, and she was prescribed antidepressant medication by her family doctor. Due to worsening of symptoms she was hospitalised and later referred to a specialised outpatient clinic for affective disorders. At entry to the clinic she suffered from constant tiredness, lack of energy, failing concentration, problems falling asleep as well as interrupted sleep. She drank about three litres of cola daily, and she had developed a metabolic syndrome.The patient fulfilled the ICD-10 criteria for dependency, and on the Yale Food Addiction Scale (YFAS) she scored 40 points. Her clinical mental status was at baseline assessed by the Major Depression Inventory (MDI) = 41, Hamilton Depression - 17 item Scale (HAMD-17) = 14, Young Mania Rating Scale (YMRS) = 2 and the Global Assessment of Functioning (GAF) Scale = 45.During cognitive therapy sessions she was guided to stop drinking cola and was able to moderate her use to an average daily consumption of 200 ml of cola Her concentration improved and she felt mentally and physically better. At discharge one year after entry her YFAS was zero. She was mentally stable (MDI =1, HAMD-17 = 0, YMRS = 0 and GAF = 85) and without antidepressant medication. She had lost 7.2 kg, her waistline was reduced by 13 cm and the metabolic syndrome disappeared.
CONCLUSION:
This case serves as an example of how the overconsumption of a caffeinated soft drink likely was causing or accentuating the patient's symptoms of mental disorder. When diagnosing and treating depression, health professionals should pay attention to potential overuse of cola or other caffeinated beverages.

 A case of cola dependency in a woman with recurrent depression.

Пропранолол в профилактике рецидивов зависимостей

However, the research also suggests that treatment with the β-blocker propranolol can block stress-induced impairment in decision-making in these individuals, potentially reducing the risk for stress-related relapse.

Beta-Blocker May Prevent Stress-Related Relapse in Addicts

Когнитивная дисфункция при злоупотреблении психоактивными веществами

Novel Therapies for Cognitive Dysfunction Secondary to Substance Abuse

Эндоканнабиноиды и бег

Recent findings show that exercise increases serum
concentrations of endocannabinoids, a result suggestive of a
new possible explanation for a number of these changes.
Further research is necessary to characterise the precise
nature of this endocannabinoid response to exercise, speci-
fically the relative importance of factors such as the nature of
the activity, exercise duration, exercise intensity, sex, and
age. In addition, animal models can be used to identify the
production and binding sites of endocannabinoids as well as
their functional role in exercise.
The cannabinoids produce psychological states that closely
parallel several experiences described as being related to the
runner’s high. Compared with the opioid analgesics, the
analgesia produced by the endocannabinoid system is more
consistent with exercise induced analgesia. Activation of the
endocannabinoid system also produces sedation, anxiolysis, a
sense of wellbeing, reduced attentional capacity, impaired
working memory ability, and difficulty in time estimation.
This behavioural profile is similar to the psychological
experiences reported by long distance runners. Considerable
research is needed to clarify to what extent the endocanna-
binoid system might be responsible for the exercise induced
changes in mental status. Nevertheless, a significant upre-
gulation of serum concentrations of endocannabinoids has
recently been reported in endurance athletes, and studies are
underway to explore this further in laboratory animals.
The close interaction of endocannabinoids with dopamine
shows that they have a function in the brain’s reward system
and therefore possibly addiction. The endocannabinoid
system is also implicated in the control of motor activity
mediated through the basal ganglia, and central activation of
anandamide in freely moving rats has been demonstrated.
Finally, the endocannabinoid system mediates peripheral
effects such as vasodilation and bronchodilation that may
play a contributory role in the body’s response to exercise.

Endocannabinoids and exercise

Ацетилцистеин в психиатрической практике

Through its metabolic contribution to glutathione production, cysteine participates in the general antioxidant activities of the body. Through its role as a modulator of the glutamatergic system, cysteine influences the reward-reinforcement pathway. Because of these functions, NAC may exert a therapeutic effect on psychiatric disorders allegedly related to oxidative stress (e.g., schizophrenia, bipolar disorder) as well as psychiatric syndromes characterized by impulsive/compulsive symptoms (e.g., trichotillomania, pathological nail biting, gambling, substance misuse). While the dosages, pharmacological strategies (monotherapy versus augmentation), and long-term risks are not fully evident, NAC appears to be a promising, relatively low-risk intervention.

Getting a Knack for NAC

Алкоголизм функционально хорошо заменяется депрессивным состоянием партнера. В системной модели "Спасатель" описывается динамика гиперфункциональности и гипофункциональности в семье: тот, кто спасает - гиперфункционал. Рядом с гиперфункционалом для прочных отношений должен быть гипофункционал. Гипофункциональность задается не только алкоголизмом, наркоманией, но и депрессией. В функциональных семьях так же может развиваться динамика гипер- и гипофункциональности. Например, жена может давать мужу сообщение, что он не достаточно эффективен просто тем, что она сама очень функциональна. Он только соберется что-то сделать, а она уже все сделала. Она - быстрее, энергичнее, и у него формируется ощущение несостоятельности. Один мой клиент рассказывал мне, что в своем первом браке он очень много делал всего по дому. Его первая жена была медлительная и очень нетребовательная. Во втором браке он ничего не делал по хозяйству. Говорил: "Ничего не хочется делать. Жена сама все лучше и быстрее делает, и вообще она всегда недовольна тем, что я делаю". Понятно, что жена была так же недовольна и тем, что муж ничего не делал, не был включен в семейную жизнь.

Семейные мифы в практике системной семейной психотерапии

налтрексон

While naltrexone has yet to become the huge treatment breakthrough for alcoholism that addiction researchers hoped for it, naltrexone did, in the end, prove to be the first anti-craving medication widely available for alcoholics. Using an opiate antagonist as an aid to the prevention of alcoholic relapse would have been unthinkable without the underpinnings of a neurophysiological model of addiction. Various investigators have also speculated that naltrexone, the drug used as an adjunct of heroin withdrawal therapy, may find use against symptoms of marijuana withdrawal in people prone to marijuana dependence

Naltrexone has something of a mixed reputation, however, in part due to its use in the highly controversial practice of “rapid detox.” Naltrexone, like methadone and buprenorphine, blocks the heroin high in a relatively neutral manner. It does so by knocking the opiate molecule off its receptors and replacing it with “dead weight,” so to speak. Naltrexone would seem to be the perfect drug for heroin addicts—but it is not. It does little to reduce cravings. Like acamprosate for alcohol, another blocking approach, its record of accomplishment is mixed, and the dropout rate is high. There is not even a mild drug-like effect to provide cross-tolerance and dampen the effects of withdrawal, as with methadone. Recently, naltrexone for heroin addiction has been offered as a form of rapid detoxification.

Naltrexone combined with buprenorphine is marketed as Subutex, and represents another treatment modality for opiate addiction. In addition, a University of Minnesota study of kleptomania—the compulsion to steal—showed that naltrexone drastically reduced stealing among a group of 25 shoplifters.

Unfortunately, naltrexone is a potential problem for people with liver disease or hepatitis. At high doses, naltrexone has been implicated in liver damage. More common adverse effects include dizziness, lethargy, and headache.

Addiction Inbox

Неотложные состояния при аффективных расстройствах

Pharmacological treatments for bipolar disorder can cause or compound patients' behavioral disturbances. Treatment with antipsychotics can increase the risk of agitation or aggression by causing akathisia, which can be associated with severe exacerbation of symptoms or even suicide attempts. The risk of akathisia is reduced but not eliminated by the use of atypical antipsychotics. Antidepressant agents can cause activation or mood destabilization, and some of these agents have been reported to cause akathisia.

Principles of treatment

A treatment strategy for impulsivity or aggression requires knowledge about possible interacting causes of the behavioral disturbance, its course, and its context. This information is helpful in formulating initial treatment and is even more helpful in developing a long-term strategy that will, if successful, reduce the patient's need for future emergency care.

Factors that influence treatment of pathological impulsivity and aggression include:

* Degree of premeditation versus degree of impulsiveness.
* Role of nonpsychiatric conditions (drug toxicity, drug withdrawal, delirium, dementia, infection, metabolic abnormality).
* Relationship to a DSM-IV Axis I psychiatric disorder.
* Relationship to a personality disorder.
* Course (acute/fluctuating versus chronic).
* Presence of prominent overstimulation.
* Environmental context (legal, relationship, and/or economic problems or changes).
* Personal context (personality characteristics, conflicts).

Candidate mechanisms of treatment for impulsive aggression or agitation include:

* Enhancing an inhibitory system, such as serotonin or GABA.
* Inhibiting an activating system, such as dopamine.
* Stabilizing fluctuations in inhibitory and/or excitatory systems.
* Protecting against overstimulation or normalizing arousal.

Psychiatric Emergencies in Bipolar and Related Disorders

Нестандартные методы лечения аддикций

Virtual reality graded exposure
VRGET is a rapidly emerging technological intervention with a wide range of promising clinical applications for psychiatric disorders, including posttraumatic stress disorder, phobias, eating disorders, cognitive rehabilitation following stroke, and substance abuse and dependence. Most virtual reality tools are in the early stages of development and are not commercially available. VRGET protocols have been created with the goal of stimulating drug or alcohol craving in patients followed by response prevention and desensitization.

Nonconventional and Integrative Treatments of Alcohol and Substance Abuse

Акампросат

Acamprosate May Be Helpful to Treat Alcohol Dependence

Распространённость и факторы риска развития маниакальных и гипоманиакальных состояний при терапии антидепрессантами

Antidepressant-induced manias have been reported with all major antidepressant classes in a subgroup of about 20-40% of bipolar patients. Lithium may confer better protection against this outcome when compared with other standard mood stabilizers, although switch rates have been reported with comparable frequencies on or off mood stabilizers. Evidence across studies most consistently supports an elevated risk in patients with (i) previous antidepressant-induced manias, (ii) a bipolar family history, and (iii) exposure to multiple antidepressant trials.

ANTIDEPRESSANT-INDUCED MANIA: AN OVERVIEW OF CURRENT CONTROVERSIES

Switches to hypomania or mania occurred in 27% of all patients (N = 12) (and in 24% of the subgroup of patients treated with SSRIs [8/33]); 16% (N = 7) experienced manic episodes, and 11% (N = 5) experienced hypomanic episodes. Sex, age, diagnosis (bipolar I vs. bipolar II), and additional treatment did not affect the risk of switching. The incidence of mood switches seemed not to differ between patients receiving an anticonvulsant and those receiving no mood stabilizer. In contrast, mood switches were less frequent in patients receiving lithium (15%, 4/26) than in patients not treated with lithium (44%, 8/18; p = .04). The number of previous manic episodes did not affect the probability of switching, whereas a high score on the hyperthymia component of the Semistructured Affective Temperament Interview was associated with a greater risk of switching (p = .008).

Antidepressant-induced mania in bipolar patients: identification of risk factors.

Antidepressant-induced mania or hypomania was evident in 39.6% (21/53) of the study group. Patients who developed manic features soon after starting an antidepressant had more antidepressant trials per year than those who did not (p < .05). A history of substance abuse and/or dependence was associated with substantially increased risk for antidepressant-induced mania (odds ratio = 6.99, 95% CI = 1.57 to 32.28, p = .007). Concomitant mood stabilizers were not uniformly associated with protection against inductions of mania during antidepressant trials.

The association between substance abuse and antidepressant-induced mania in bipolar disorder: a preliminary study

Биомаркеры злоупотребления алкоголем

‘I’m sober, Doctor, really’: Best biomarkers for underreported alcohol use

Вакцина от кокаиновой зависимости

Cocaine is a very simple molecule, but you can attach a simple molecule to a complex molecule and still trigger the immune system. You can use this method to develop antibodies to cocaine. When an individual uses cocaine, the antibodies will bind to the cocaine in the blood stream and the drug never reaches the brain because the molecule is now too large to pass the blood-brain barrier.

Pharmacotherapy for cocaine dependence: Most evidence is weak

Study	Design	Results
Disulfiram
Pani et al, 20108	Meta-analysis of 7 studies with 492 cocaine-dependent patients	Researchers found ‘low evidence’ supporting disulfiram for treating cocaine dependence
Modafinil
Dackis et al, 20059	62 cocaine-dependent patients randomized to modafinil, 400 mg/d, or placebo for 8 weeks	Patients receiving modafinil provided significantly more BE-negative urine samples and were significantly more likely to achieve ≥3 weeks of cocaine abstinence
Anderson et al, 200910	210 cocaine-dependent patients randomized to modafinil, 200 mg/d or 400 mg/d, or placebo for 12 weeks	Modafinil significantly reduced cocaine craving but did not significantly improve the average weekly percentage of cocaine non-use days
Tiagabine
Winhusen et al, 200711	141 cocaine-dependent patients randomized to tiagabine, 20 mg/d, or placebo for 12 weeks	No significant changes in cocaine use vs placebo as measured by self-report and urine BE
Baclofen
Kahn et al, 200912	Cocaine-dependent patients randomized to baclofen, 60 mg/d, or placebo for 8 weeks	No significant difference between groups in cocaine use as measured by urine BE
Ondansetron
Johnson et al, 200613	63 cocaine-dependent patients randomized to ondansetron, 0.25 mg, 1 mg, or 4 mg twice daily, or placebo for 10 weeks	The odansetron 4 mg group had a significantly greater rate of improvement in percentage of patients with a cocaine-free week compared with the placebo group
BE: benzoylecgonine

Vaccine for cocaine addiction: A promising new immunotherapy

Прегабалин: злоупотребление, зависимость, синдром отмены

Pregabalin is a GABA-analog that selectively binds to the alpha2 delta subunit of voltage-gated calcium channels. It inhibits the release of excitatory neurotransmitters and increases neuronal GABA levels. Like some other compounds that modulate GABA-ergic neurotransmission, pregabalin might have a potential for abuse. Our patient had a history of drug addiction, which may be important in the reward effect of pregabalin. We therefore recommend being especially cautious when using pregabalin to treat patients with a history of drug or alcohol dependence.

Pregabalin Abuse, Dependence, and Withdrawal: A Case Report

Pittenger C, Desan PH: Gabapentin abuse, and delirium tremens upon gabapentin withdrawal. J Clin Psychiatry 2007

Vicctorio-Vigneau C, Guerlais M, Jolliet P: Abuse, dependency and withdrawal with gabapentin: a first case report

Потенциирование трийодтиронином при недостаточном ответе на терапию ТЦА

"The exact mechanism of action of T3 augmentation remains largely unknown. In depressed patients, the circulating plasma levels of free T4 appear to be normal,
but levels of free T3 may be decreased. Approximately one third of depressed patients show blunting of the TSH response to thyrotropin releasing hormone.
Approximately 15% of depressed patients have elevated basal TSH levels, probably indicating subclinical hypothyroidism, and thyroid autoantibodies
are found in a similar percentage of patients.11
Thyroid abnormalities are found at a higher frequency among TCA nonresponders and this may link with the underlying mechanism of T3 augmentation.In most case reports, patients had normal thyroid function, as in our second case. There seems to be no
relationship between thyroid state and the efficacy of T3 augmentation. In the first case, the patient had sick euthyroid syndrome, which is sometimes seen in
depressed patients. In this condition, peripheral deiodination of T4 to T3 is reduced, although the TSH level is normal.
One proposed mechanism of T3 augmentation is that T3 may raise peripheral thyroid hormone concentrations in patients with covert or borderline hypothyroidism. Other authorities believe that there is no difference in the thyroid state of the
responders and nonresponders to T3 augmentation. 12 L-triiodothyronine may act in euthyroid patients through augmentation of the β-adrenergic system.13 Alternatively, T3 may also affect thyroid utilisation and local neuronal deiodination in the brain."

"The usual dose of T3 in augmentation therapy is 25 µg/d to 50 µg/d. A starting dose of 20 µg increasing to 40 µg was given to the patients in this study. Initial improvement in mood is usually apparent within several days. Goodwin et al reported that there was improvement in all aspects of the depressive syndrome within 1 to 3 days. For the two patients in this study,initial responses were noted after 3 and 7 days. An adequate trial of T3 augmentation should last for 7 to 14 days to reach its full effect. If T3 augmentation is effective, most studies recommend a maintenance
period of 2 months before gradually reducing the dose at the rate of 10 µg every 3 to 7 days."

Triiodothyronine augmentation for the treatment of depression in substance misusers unresponsive to tricyclic antidepressants.

Гэмблинг вызваный прамипексолом

BACKGROUND: Dopamine agonists (DAs), long used in treating Parkinson’s disease and effective in relieving symptoms of restless legs syndrome, have frequently been reported to induce problematic compulsive behaviors (e.g., obsessive gambling, hypersexuality) in individuals who had never had difficulties with such behaviors before. OBJECTIVE: The authors report two cases that add to a small-but-growing literature suggesting that these drugs be dispensed with appropriate caution. METHOD: The authors describe two patients seen in a psychiatric setting—one, after a suicide attempt, and one with depression—both resulting from intractable compulsive gambling. RESULTS: In both instances, control of gambling was achieved: in one, when pramipexole was discontinued, and in the other, after substitution of ropinirole and addition of spiritual and support-group approaches. DISCUSSION: DAs stimulate pathways that govern reward behavior, including pleasure and addiction. Other reward behaviors, such as eating and sexual activity, may also be affected by DAs. These cases demonstrate a clear temporal relationship between initiation and behavioral change; patients and their caregivers should be alerted to the possibility of such changes.

Impact of Dopamine Agonists on Compulsive Behaviors: A Case Series of Pramipexole-Induced Pathological Gambling

вигабатрин в терапии кокаиновой зависимости

OBJECTIVE: Cocaine dependence is associated with severe medical, psychiatric, and social morbidity, but no pharmacotherapy is approved for its treatment in the United States. The atypical antiepileptic vigabatrin ({gamma}-vinyl gamma-aminobutyric acid [GABA]) has shown promise in animal studies and open-label trials. The purpose of the present study was to assess the efficacy of vigabatrin for short-term cocaine abstinence in cocaine-dependent individuals. METHOD: Participants were treatment seeking parolees who were actively using cocaine and had a history of cocaine dependence. Subjects were randomly assigned to a fixed titration of vigabatrin (N=50) or placebo (N=53) in a 9-week double-blind trial and 4-week follow-up assessment. Cocaine use was determined by directly observed urine toxicology testing twice weekly. The primary endpoint was full abstinence for the last 3 weeks of the trial. RESULTS: Full end-of-trial abstinence was achieved in 14 vigabatrin-treated subjects (28.0%) versus four subjects in the placebo arm (7.5%). Twelve subjects in the vigabatrin group and two subjects in the placebo group maintained abstinence through the follow-up period. The retention rate was 62.0% in the vigabatrin arm versus 41.5% in the placebo arm. Among subjects who reported prestudy alcohol use, vigabatrin, relative to placebo, was associated with superior self-reported full end-of-trial abstinence from alcohol (43.5% versus 6.3%). There were no differences between the two groups in drug craving, depressed mood, anxiety, or Clinical Global Impression scores, and no group differences in adverse effects emerged. CONCLUSIONS: This first randomized, double-blind, placebo-controlled trial supports the safety and efficacy of short-term vigabatrin treatment of cocaine dependence.

Randomized, Double-Blind, Placebo-Controlled Trial of Vigabatrin for the Treatment of Cocaine Dependence in Mexican Parolees