Early central Glutamate and GABA changes with Baclofen and Acamprosate among patients with alcohol dependence syndrome: A magnetic resonance spectroscopy based prospective study

BACKGROUND: Alcohol dependence syndrome is a global illness and anticraving medications are one of its management approaches. Understanding of mechanism of action of anticraving agents in alcohol dependence syndrome (ADS) is limited. AIM: The authors investigated early changes of central glutamate and GABA with Acamprosate and Baclofen among patients with ADS. METHODS: Forty patients with ADS were recruited with purposive sampling. At the end of detoxification (CIWA-Ar<10) central glutamate and GABA were measured with magnetic resonance spectroscopy. SADQ, PACS were administered. Either Acamprosate or Baclofen was started with double blind random allocation. After 25 days of starting Baclofen or Acamprosate measures were repeated. RESULTS: Both groups had shown comparable changes in craving, glutamate, and GABA levels. SAD-Q, PACS baseline and CIWA-Ar baseline were negatively corelated with GABA change in Baclofen group raising a speculation that whether Baclofen would be more effective in less severe dependence or vice-versa. In Acamprosate group CIWA-Ar baseline was positively corelated with glutamate change. Baseline glutamate was negatively corelated with glutamate change in both groups but was positively correlated with GABA change in Acamprosate group only speculating that Acamprosate could be more effective than Baclofen in more severe alcohol dependence. CONCLUSIONS: Our study has shown comparable changes in Glutamate and GABA at anterior cingulate cortex during early post-detoxification period both for Baclofen and Acamprosate.