Naltrexone in patients with bipolar disorder and alcohol dependence.

Bipolar disorder is associated with very high rates of substance abuse. However, few clinical trials are reported in this population. Naltrexone is effective for alcohol dependence, but its safety and efficacy are not established in patients with bipolar disorder and alcohol dependence. A 16-week, open-label, add-on pilot study of naltrexone was conducted in 34 outpatients with bipolar disorder and alcohol dependence. Assessments included the 17-item Hamilton Rating Scale for Depression (HRSD-17), Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS), and an alcohol craving scale. Alcohol use was quantified. Significant improvement was observed in the HRSD-17 and YMRS, and days of alcohol use and craving decreased significantly. Naltrexone was well tolerated. Controlled trials are warranted.