Most treatments focus on helping people discontinue their alcohol intake, followed up with life training and/or social support to help them resist a return to alcohol use. Since alcoholism involves multiple factors which encourage a person to continue drinking, they must all be addressed to successfully prevent a relapse. An example of this kind of treatment is detoxification followed by a combination of supportive therapy, attendance at self-help groups, and ongoing development of coping mechanisms. Much of the treatment community for alcoholism supports an abstinence-based zero tolerance approach popularized by the 12 step program of Alcoholics Anonymous; however, some prefer a harm-reduction approach. Cessation of alcohol intake
Medical treatment for alcohol detoxification usually involves administration of a benzodiazepine, in order to ameliorate alcohol withdrawal syndromes adverse impact. The addition of phenobarbital improves outcomes if benzodiazepine administration lacks the usually efficacy, and phenobarbital alone might be an effective treatment. Propofol also might enhance treatment for individuals showing limited therapeutic response to a benzodiazepine. Individuals who are only at risk of mild to moderate withdrawal symptoms can be treated as outpatients. Individuals at risk of a severe withdrawal syndrome as well as those who have significant or acute comorbid conditions can be treated as inpatients. Direct treatment can be followed by a treatment program for alcohol dependence or alcohol use disorder to attempt to reduce the risk of relapse. Experiences following alcohol withdrawal, such as depressed mood and anxiety, can take weeks or months to abate while other symptoms persist longer due to persisting neuroadaptations.
Similarly, the dose should be reduced by half in those taking strong CYP2D6 inhibitors. Vortioxetine can be discontinued abruptly without tapering, but it is recommended that at doses of 15 to 20 mg/day it be tapered first to 10 mg/day one week prior to full discontinuation if possible. Available forms
Vortioxetine is available in the form of 5, 10, and 20 mg immediate-release, film-coated oral tablets. Contraindications
Vortioxetine is contraindicated in those with hypersensitivity to vortioxetine or to any other components of vortioxetine tablets. It is also contraindicated in those taking monoamine oxidase inhibitors (MAOIs) due to the possibility of serotonin syndrome. Adverse effects
The most common side effects reported with vortioxetine are nausea, vomiting, constipation, and sexual dysfunction, among others. With the exceptions of nausea and sexual dysfunction, these side effects were reported by less than or equal to 10% of study participants given vortioxetine. Significant percentages of placebo-treated participants also report these side effects. Discontinuation of treatment due to adverse effects in clinical trials was 8% with vortioxetine versus 3% with placebo.Sexual dysfunction, such as decreased libido, abnormal orgasm, delayed ejaculation, and erectile dysfunction, are well-known side effects of SSRIs and serotonin–norepinephrine reuptake inhibitors (SNRIs). In clinical trials, sexual dysfunction occurred more often with vortioxetine than with placebo and appeared to be dose-dependent. The specific incidences of treatment-emergent sexual dysfunction as measured with the Arizona Sexual Experience Scale (ASEX) were 14 to 20% for placebo and 16 to 34% for vortioxetine over a dosage range of 5 to 20 mg/day.