Psychopharmacology of Addiction

Öz

Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development. Developments in the psychopharmacology of addiction is much slower than the other disciplines of psychiatry. For a long time, social and behavioral therapeutic approaches are the only choices for the treatment of addictive disorders. Disulfiram was the only pharmacological agent approved for addiction treatment until the end of 20th century. Pharmacological treatment options available for treatment have grown along with our understanding of the neurobiological mechanisms underlying the development and persistence of addiction. Several new medications like naltrexone, acamprosate, methadone and buprenoprhine have been approved for the treatment of alcohol and opioid use disorders ever since. Based on ever-increasing information about neurotransmitter and receptors, many studies have been performed concerning craving and relapse prevention in recent years. Besides many other pharmacological agents have been focus of new researches for treatment of different types of addiction. The aim of this article is to briefly review the literature on psychopharmacology of addictive disorders and recent developments in this area.

Anahtar Kelimeler

• Addiction, Alcohol, Drug, Treatment, Immunotherapy

Bağımlılık Psikofarmakolojisi

Öz

Bağımlılık gelişiminde genetik, psikososyal ve çevresel faktörlerin rol oynadığı birincil, kronik nörobiyolojik bir hastalıktır. Bağımlılık psikofarmakolojisindeki gelişmeler psikiyatrinin diğer alanlarına göre daha yavaş bir seyir göstermiştir. Alkol ve madde bağımlılığı tedavisi uzun süre sadece sosyal ve davranışsal yaklaşımlar ile sürdürülmüştür. Yirminci yüzyılın sonuna kadar madde bağımlılığı tedavisinde onay almış tek ajan disülfiram olmuştur. Bağımlılığın oluşumu ve sürmesini sağlayan nörobiyolojik süreçlerin daha iyi anlaşılmaya başlanmasına paralel olarak farmakolojik tedavi seçeneklerinin sayısı da artmaya başlamıştır. Son yıllarda alkol ve opiyat bağımlılığı tedavisinde naltrekson, akamprosat, metadon ve buprenorfin gibi çeşitli ilaçların kullanımına izin verilmiştir. Nörotransmitter ve reseptör düzeyinde artan bilgiler ışığında, özellikle istek ve nükslerin önlenmesi konusunda halen pek çok çalışma yapılmakta, farklı bağımlılık tiplerinde kullanılmak üzere birçok farmakolojik ajanın geliştirme çabaları ve tedavi arayışları devam etmektedir. Bu yazıda alkol ve madde bağımlılığı psikofarmakolojisinde mevcut tedavi seçenekleri ve geliştirme aşamasında olan ilaçlar kısaca gözden geçirilmiştir.

Anahtar Kelimeler

• Bağımlılık, alkol, madde, tedavi, immünoterapi

Kaynakça

1. Işık E. Erişkinlerde klinik psikofarmakoloji. In Güncel Temel ve Klinik Psikofarmakoloji. (Eds E Işık, T Uzbay): 337-359. İstanbul, Golden Medya Baskı,
2. Uluğ B. Alkol kullanımı ile ilişkili bozukluklar. In Psikiyatri Temel Kitabı (Eds C Güleç, E Köroğlu): 161-172. Ankara, HYB Basım Yayın, 2007.
3. López-Muñoz F, Alamo C, Rubio G, Cuenca E. Half a century since the clinical introduction of chlorpromazine and the birth of modern psychopharmacology. Prog Neuropsychopharmacol Biol Psychiatry 2004; 28:205-208.
4. Arıkan Z. Alkol ve madde bağımlılığında tedavi ve genel ilkeleri. Türkiye Klinikleri Psikiyatri Özel 2010; 3(1):28-38.
5. İnanlı İÇ, Eren İ. Alkol bağımlılığının nörobiyolojisi ve uzun dönem ilaç tedavisinde yenilikler. Psikiyatride Derlemeler, Olgular ve Varsayımlar 2007; 1(1):17-28.
6. Tayyareci Y, Acarel E. Acute myocardial infarction associated with disulfiram-alcohol interaction. Turk Kardiyol Dern Ars 2009; 37:48-50.
7. Jeronimo A, Meira C, Amaro A, Campello GC, Granja C. Cardiogenic shock caused by disulfiram. Arq Bras Cardiol 2009; 92(3):e16-18.
8. Mirsal H, Yalug I, Tan D, Stern TA, Kalyoncu A, Pektas O et al. Delirium-associated disulfiram and ethanol interactions. Prim Care Companion J Clin Psychiatry 2005; 7:235-237.

9. Huffman JC, Stern TA. Disulfiram use in an elderly man with alcoholism and heart disease: a discussion. Prim Care Companion J Clin Psychiatry 2003; 5:41-44.
10. Wıllıams SH. Medications for treating alcohol dependence. Am Fam Physician 2005; 72:1775-1780.
11. Nasrallah H. Vulnerability to disulfiram psychosis. West J Med 1979; 130:575-577.
12. Gossop M, Carroll KM. Disulfiram, cocaine, and alcohol: two outcomes for the price of one? Alcohol Alcohol 2006; 41:119-120.
13. Pani PP, Trogu E, Vacca R, Amato L, Vecchi S, Davoli M. Disulfiram for the treatment of cocaine dependence. Cochrane Database Syst Rev 2010; 1:CD007024.
14. Collins GB, McAllister MS, Adury K. Drug adjuncts for treating alcohol dependence. Cleve Clin J Med 2006; 73:641-656.
15. Graham R, Wodak AD, Whelan G. New pharmacotherapies for alcohol dependence. Med J Aust 2002; 177:103-107.
16. Wright TM, Myrick H. Acamprosate: a new tool in the battle against alcohol dependence. Neuropsychiatr Dis Treat 2006; 2:445-453.
17. Kiefer F, Wiedemann K. Combined therapy: what does acamprosate and naltrexone combination tell us? Alcohol Alcohol 2004; 39:542-547.
18. Kiefer F, Jahn H, Tarnaske T, Helwig H, Briken P, Holzbach R et al. Comparing and combining naltrexone and acamprosate in relapse prevention of alcoholism. Arch Gen Psychıatry 2003; 60:92-99.
19. Ray LA, Hutchison KE. Effects of naltrexone on alcohol sensitivity and genetic moderators of medication response: a double-blind placebo-controlled study. Arch Gen Psychiatry 2007; 64:1069-1077.
20. Johnson B. Naltrexone long-acting formulation in the treatment of alcohol dependence. Ther Clin Risk Manag 2007; 3:741-749.
21. Baltieria DA, Andrade AG. Efficacy of acamprosate in the treatment of alcohol- dependent outpatients. Rev Bras Psiquiatr 2003; 25:156-159.
22. Mason BJ, Heyser CJ. Acamprosate: a prototypic neuromodulator in the treatment of alcohol dependence. CNS Neurol Disord Drug Targets 2010; 9:23-32.
23. Kosten TR, George TP. The neurobiology of opioid dependence: implications for treatment. Sci Pract Perspect 2002; 1:13-20.
24. Ross S, Peselow E. Pharmacotherapy of addictive disorders. Clin Neuropharmacol 2009; 32:277-289.
25. Tellioğlu T. Buprenorphine: a new alternative in the treatment of opioid addiction. Klinik Psikofarmakoloji Bülteni 2010; 20:261-265.
26. Altınyazar V. Psikiyatride sık karşılaşılan toksik sendromlar. Psikiyatride Güncel Yaklaşımlar 2010; 2:532-571.
27. Soyka M, Rösner S. Opioid antagonists for pharmacological treatment of alcohol dependence: a critical review. Curr Drug Abuse Rev 2008; 1:280-291.
28. Patel KH. Pharmacologic management of alcohol dependence. US Pharmacist 2009; 34:1-4.
29. Graham K, Massak A. Alcohol consumption and the use of antidepressants. CMAJ 2007; 176:633-637.
30. Muhonen LH, Lahti J, Sinclair D, Lönnqvist J, Alho H.. Treatment of alcohol dependence in patients with co-morbid major depressive disorder-predictors for the outcomes with memantine and escitalopram medication. Subst Abuse Treat Prev Policy 2008; 3:20.
31. Garcia-Portilla MP, Bascaran MT, Saiz PA, Mateos M, González-Quirós M, Pérez P et al. Effectiveness of venlafaxine in the treatment of alcohol dependence with comorbid depression. Actas Esp Psiquiatr 2004; 33:41-45.
32. Güveli H, Saatçioğlu Ö. Alkol bağımlılığında içme isteği. Klinik Psikofarmakoloji Bülteni 2008; 18:140-152.
33. Evren C. Sosyal anksiyete bozukluğu ve alkol kullanım bozuklukları. Psikiyatride Güncel Yaklaşımlar 2010; 2:473-515.
34. Kenna GA. Medications acting on the serotonergic system for the treatment of alcohol dependent patients. Curr Pharm Des 2010; 16:2126-2135.
35. Johnson BA, Roache JD, Ait-Daoud N, ve ark. Ondansetron reduces the craving of biologically predisposed alcoholics. Psychopharmacology (Berl) 2002; 160:408-413.
36. Boztaş MH, Arısoy Ö. Uçucu madde bağımlılığı ve tıbbi sonuçları. Psikiyatride Güncel Yaklaşımlar 2010; 2:516-531.
37. Hutchison KE, Ray L, Sandman E, Rutter MC, Peters A, Davidson D et al. The effect of olanzapine on craving and alcohol consumption. Neuropsychopharmacology 2006; 31:1310-1317.
38. Azorin JM, Bowden CL, Garay RP, Perugi G, Vieta E, Young AH. Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism. Neuropsychiatr Dis Treat 2010; 6:37-46.
39. Wiesbeck GA, Weijers HG, Lesch OM, Glaser T, Toennes PJ, Boening J. Flupenthixol decanoate and relapse prevention in alcoholics: results from a placebo- controlled study. Alcohol Alcohol 2001; 36:329-334.
40. Evren C, Karatepe HT, Aydın A, Dalbudak E, Çakmak D. Alkol/madde bağımlıla- rında ketiapinin etkisi ve kötüye kullanımı: olgu serisi ve gözden geçirme. Klinik Psikofarmakoloji Bülteni 2009; 19:148-154.
41. Erdoğan S. Madde kullanım bozukluklarında ketiyapinin yeri, kötüye kullanım ve bağımlılık olasılığı: bir gözden geçirme. Turk Psikiyatri Derg 2010; 21:167-175.
42. Martinotti G, Di Nicola M, Di Giannantonio M, Janiri L. Aripiprazole in the treatment of patients with alcohol dependence: a double-blind, comparison trial vs. Naltrexone. J Psychopharmacol 2009; 23:123-129.
43. Wang LL, Yang AK, He SM, Liang J, Zhou ZW, Li Y et al. Identification of molecular targets associated with ethanol toxicity and implications in drug development. Curr Pharm Des 2010; 16:1313-1355.
44. Erdoğan A, Yurteri N. Aripiprazole treatment in the adolescent patients with inhalants use disorders and conduct disorder: a retrospective case analysis. Yeni Symposium 2010; 48:229-233.
45. Miranda JJF, Gonzalez PAM, Perez MM, Díaz González T, Cienfuegos EG, Díaz MJA et al.. Topiramate as add-on therapy in non-respondent alcohol dependant patients: a 12 month follow-up study. Actas Esp Psiquiatr 2007; 35:236-242.
46. Johnson BA, Rosenthal N, Capece JA, Wiegand F, Mao L, Beyers K et al. Topiramate for treating alcohol dependence: a randomized controlled trial. JAMA 2007; 298:1641-1651.
47. Rubio G, Lopez-Munoz F, Alamo C. Effects of lamotrigine in patients with bipolar disorder and alcohol dependence. Bipolar Disord 2006; 8:289-293.
48. Kampman KM. New medications for the treatment of cocaine dependence. Ann Ist Super Sanita 2009; 45:109-115.
49. Maciulaitis R, Kontrimaviciute V, Bressolle FM, Briedis V. Ibogaine, an anti- addictive drug: pharmacology and time to go further in development. A narrative review. Hum Exp Toxicol 2008; 27:181-194.
50. Montoya ID. Immunotherapies for drug addictions. Adicciones 2008; 20:111-116.
51. Gentry WB, Rüedi-Bettschen D, Owens SM. Development of active and passive human vaccines to treat methamphetamine addiction. Hum Vaccin 2009; 5:206-213.
52. Moreno AY, Janda KD. Immunopharmacotherapy: vaccination strategies as a treatment for drug abuse and dependence. Pharmacol Biochem Behav 2009; 92:199- 205.
53. Orson FM, Kinsey BM, Singh RAK, Wu Y, Kosten TR. Vaccines for cocaine abuse. Hum Vaccin 2009; 5:194-199.
54. Tsankova N, Renthal W, Kumar A, Nestler EJ. Epigenetic regulation in psychiatric disorders. Nat Rev Neurosci 2007; 8:355-367.
55. Şengül C, Herken H. Genetikten epigenetiğe alkol bağımlılığı. Anadolu Psikiyatri Dergisi 2009; 10:239-245.
56. Lane AA, Chabner BA. Histone deacetylase inhibitors in cancer therapy. J Clin Oncol 2009; 27:5459-5468.
57. Ptak C, Petronis A. Epigenetic approaches to psychiatric disorders. Dialogues Clin Neurosci 2010; 12:25-35.
58. Bonoiu AC, Mahajan SD, Ding H, Roy I, Yong KT, Kumar R et al. Nanotechnology approach for drug addiction therapy: gene silencing using delivery of gold nanorod- siRNA nanoplex in dopaminergic neurons. Proc Natl Acad Sci USA 2009; 106:5546
59. Tuğçe Toker Uğurlu, Dr., Pamukkale Üniversitesi Tıp Fakültesi Psikiyatri Anabilim Dalı, Denizli; Ceyhan
60. Balcı Şengül, Uzm.Dr., Denizli Devlet Hastanesi, Denizli; Cem Şengül, Doç.Dr., Pamukkale Üniversitesi Tıp
61. Fakültesi Psikiyatri Anabilim Dalı, Denizli