Antidepressants and the Treatment of Alcohol Withdrawal

ANTIDEPRESSANTS AND THE TREATMENT OF ALCOHOL WITHDRAWAL 8

Antidepressantsand the Treatment of Alcohol Withdrawal

Antidepressantsand the Treatment of Alcohol Withdrawal

1. Identifyingthe research question/ clinical issue:

  • What is the research question or clinical issue addressed by this review article? Is there a clearly defined research question/statement?

Themain research question that the review article addresses is clearlydefined as the evaluation of the safety and effectiveness ofpharmacological interventions in treating withdrawal from alcohol.

  • Is the reason why this research question is important or significant presented by the authors?

Theimportance of the research question and undertaking the review iswell acknowledged by the authors. It is imperative that policymakers,patients and clinicians alike have clear knowledge on any crucialvariation in the treatment for alcohol withdrawal with regard toefficacy and safety. The article aims at presenting a systematicreview and summary of the available evidence pertaining topharmacological interventions.

  • Briefly summarize the research question/ issue and the reason for this review.

Alcoholabuse has been quite prevalent in the contemporary human society.Unfortunately, the high rates of alcohol addiction and consumptionaffect the productivity of the individuals and the countries atlarge. Numerous strategies for rehabilitating alcohol addicts havebeen devised. However, a large number of addicts relapse or quit therehabilitation after a short time as a result of the withdrawalsymptoms. Pharmacological interventions have been devised so as toeliminate or assuage the withdrawal symptoms. While these medicationshave been effective, it is imperative that the manner in which theywork is evaluated, as well as the efficacy of the varied medicationsassessed so as to determine the ones that would be most appropriatein terms of safety, efficacy and compatibility.

2. Evaluating the inclusion criteria:

  • How many studies were reviewed as a part of this systematic review?

Atotal of 114 studies that had a combined total of 7333 participantswere deemed to have satisfied the inclusion criteria and, therefore,reviewed in the assessment.

  • How did the authors go about finding these articles? What was their search strategy?

Thesearch for appropriate studies and articles was carried out in theCochrane Database of Systematic Review, where two authorsautonomously searched and extracted data, as well as summarized thefundamental traits of the reviews. Some of the search or MESH termsthat were used included Alcohol-induced disorders, nervous system(Mesh), substance withdrawal syndrome (mesh), alcohol-relateddisorders (mesh), among others. In addition they evaluated thequality of the reviews using AMSTAR.

  • What were their inclusion/exclusion criteria for deciding which articles they would include in this review?

Therewere varied characteristics that were evaluated in determining theappropriateness of particular articles. With regard to the type ofparticipants in the studies, only alcohol dependent patients whosediagnosis had been carried out in line with the appropriatestandardized criteria such as DSM-IV-I or ICD and who had undergonealcohol withdrawal symptoms irrespective of their severity. Withregard to the form of interventions, articles that had experimentalinterventions or even control interventions were considered. Therewas also consideration of the types of outcomes including efficacyoutcomes such as craving as determined through validated measurement,withdrawal symptoms as determined through pre-specified scales,withdrawal delirium and withdrawal seizures. With regard to safetyoutcomes, two outcomes would be evaluated including severe and fataladverse events, or simply adverse events. Acceptability outcomesincluded dropout as a result of the adverse effects

3. Understanding the quality of the research:

  • How do the authors describe the quality of the articles included in this review?

Thequality of the articles that were included in the review is describedas widely varied as they, in totality, would not offer sufficientevidence pertaining to the effectiveness of pharmacologicalinterventions in eliminating the withdrawal symptoms of alcohol.Nevertheless, the articles incorporated widely varying studiesregarding the techniques of reporting and recording the efficacy ofthe medications. Further, it was difficult to eliminate or minimizebias since a large proportion of the articles did not incorporatesufficient information regarding the bias.

  • Is there a discussion of the population represented by the articles included in this review? Do the authors discuss the characteristics of the populations for which the conclusions of their review apply, and those populations for whom the findings may not apply?

Thecharacteristics of the populations that were included in the revieware included in the paper. Indeed,

Theauthors incorporate a review of the participants that took part inthe studies examining specific medications such as GHB,benzodiazepines, anti-convulsants, psychotropic analgesic nitrousoxide (PAN) and Baclofen. Nevertheless, there is no informationregarding the populations for whom the conclusions for the researchwould be applicable. This does not negate the fact that thedistinctive characteristics of medications and participants would beinclusion criteria with regard to the applicability of the resources.

4. Judgingthe review’s consistency and clarity:

  • Do the authors’ conclusions and recommendations (if any) make sense to you?

Theconclusions of the authors make sense to me. It is stated that of thefour treatments that are under consideration, the benzodiazepinesexhibited protective benefits against symptoms of withdrawal,especially seizures in comparison to placebo, as well as likelyprotective benefits for a large number of outcomes when compared toantipsychotic medications. Nevertheless, there is fragmented andsparse data pertaining to the likely harm.

  • What points have the authors made clearly? What parts of the article or the authors’ conclusions are not as clear to you, or are confusing?

Theauthors clearly state that the safety and effectiveness of thebenzodiazepines could not be conclusively determined as a result ofthe heterogeneity of trials in the assessment of outcomes andinterventions. This is confusing considering the previously statedbenefit of benzodiazepines over the other categories ofinterventions.

  • Did the authors answer the research question/issue they described at the start of the article?

Theauthors managed to answer the question that they outlined at thebeginning of the article. Nevertheless, there was insufficientevidence pertaining to the safety and efficacy of somepharmacological interventions such as baclofen and GHB as few studiesconsidered them and there existed no variations in comparison toother categories and the placebo.

5. Applicabilityto nursing practice:

  • How would you rate the overall strength of evidence presented in this systematic review? For example, does this review demonstrate that we have a lot of evidence to guide practice in a certain way? Or does it point out that the evidence is very mixed and inconclusive? Or does it demonstrate that there has been very limited research to clearly answer our question?

Whilethe evidence that is offered in the systematic review may beconsidered as sufficiently strong, it is generally inconclusive andmixed since the effectiveness of some measures could not bedetermined due to insufficient work on the same. Further, the datapertaining to the potential dangers of the pharmacologicalinterventions is pretty much fragmented, thereby affecting thequality of results and conclusions.

  • How does reading and evaluating this systematic review influence or make you think about your own nursing practice?

Inspite of the limitations of the research, it influences my nursingpractice as it demonstrates the favorability of interventions incurbing or eliminating the withdrawal symptoms for recoveringalcoholics. This would inform my choice of interventions when facedwith a case of recovering addicts.

  • What questions about the “evidence base” of other areas/topics relevant to your nursing practice does this bring up for you? List at least two additional questions or topics you would be interested in looking up on the Cochrane Database of Systematic Reviews.

Twoquestions that have been triggered by the research include

  1. What is the efficacy of traditional techniques of rehabilitation in eliminating the withdrawal symptoms?

  2. Does the health and age of the alcoholics and length of time of addiction affect the efficacy of the techniques used?

References

Amato,L., Minozzi, S &amp Davolu, M (2011). Efficacy and Safety ofPharmacological interventions for the treatment of the AlcoholWithdrawal Syndrome (Review). TheConchrane Library,Vol.6

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