Clinical Summary: Differences in the Severity of Alcohol Craving Between Euthymic Unipolar and Bipolar Patients

Patients with mood disorders and alcohol use disorder often relapse even when mood symptoms are quiet, and craving is a key driver of that risk. This study asks a practical question for outpatient care: among euthymic patients with dual diagnosis, does alcohol craving differ between major depressive disorder and bipolar disorder, and do biologic markers track with that craving burden?

Design This was a prospective, observational, cross-sectional study

N A total of 50 patients

Population 31 patients (6 females and 25 males; mean age: 49.8 years, SD=10.2) diagnosed with AUD comorbid with MDD

Duration Participants were consecutively recruited over a 12-month period, from June 2015 to May 2016.

Key Findings

Among the 50 enrolled patients, group 1 included 31 patients with AUD comorbid with MDD and group 2 included 19 patients with AUD comorbid with BD (5 BD I and 14 BD II); patients in group 1 had significantly higher VAS and AUDIT scores, as well as a greater percentage of plasma CDT, compared to group 2.
In the MDD group, VAS scores were positively correlated with AUDIT scores (P<.001), plasma homocysteine concentrations (P=.000848), and CDT percentage (P =.020063).
In the BD group, VAS scores were positively correlated with AUDIT scores (P<.001), plasma homocysteine concentrations (P< .001), and CDT percentage (P =.024818).
No significant correlations were found between VAS scores and age, gender, education level, or employment status in either diagnostic group.

Clinical Bottom Line

In euthymic patients with dual diagnosis, alcohol craving burden was higher in those with major depressive disorder than in those with bipolar disorder, and craving tracked with AUDIT, CDT, and homocysteine in both groups. Clinically, mood disorder subtype and biologic alcohol-use markers add useful risk information even when patients are not in an acute mood episode.

Practice Implications

Do not assume euthymia means low relapse risk: patients with AUD comorbid with MDD had significantly higher VAS and AUDIT scores and a greater percentage of plasma CDT than patients with AUD comorbid with BD.
When craving is elevated on VAS, assess concurrent alcohol-related severity and consider checking CDT and plasma homocysteine, because VAS scores were positively correlated with AUDIT, homocysteine, and CDT in both groups.
Prioritize accurate mood disorder diagnosis in patients with AUD, since the study found different craving severity profiles between comorbid MDD and BD despite euthymia.
Demographic factors were less informative here than alcohol-use measures and biomarkers, as no significant correlations were found between VAS scores and age, gender, education level, or employment status.