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Antidepressants for cocaine dependenceSilva de Lima M, Farrell M, Lima Reisser AARL, Soares B
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SummaryAntidepressants have not been proven to reduce cocaine dependence, although this may because people commonly stop using the antidepressants too soonAs dependence on cocaine became more common and caused major personal and social problems, several methods have been tried to help reduce dependence. Antidepressants are often tried to help people manage the depression and cravings that occur when people stop using cocaine. The review found that trials have not shown that antidepressants can help reduce cocaine dependence, although this may partly be because many people quit using the antidepressants. It may be that more people might benefit if they were helped to keep using antidepressants, including those who are also dependent on heroin or on methadone programs.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 23. 2001 AbstractBackgroundThe past decade has witnessed a sustained search for an effective pharmacotherapeutic agent for the treatment of cocaine dependence. While administration of cocaine acutely increases intercellular dopamine, serotonin, and norepinephrine levels by blocking their presynaptic reuptake, chronic cocaine abuse leads to down-regulation of monoamine systems. Post-cocaine use depression and cocaine craving may be linked to this down-regulation. ObjectivesTo evaluate the efficacy and the acceptability of antidepressants for cocaine dependence Search strategyWe searched Cochrane Drug and Alcohol Group Specialised Register (July 2007), MEDLINE (1966 to July 2007), CINAHL (1982 to July 2007), SCOPUS (July 2007); reference searching; personal communication; conference abstracts; unpublished trials, ongoing trials, relevant web-sites. Selection criteriaAll randomised controlled trials and controlled clinical trials which focus on the use of any antidepressants for cocaine dependence Data collection and analysisThe authors independently evaluated the papers, extracted data, rated methodological quality. Doubts were solved throug discussion between all the authors. Main results18 studies were included in the review (1177 participants). Positive urine sample for cocaine metabolites was the main efficacy outcome, with no significant results obtained regardless of the type of antidepressant. Compared to other drugs, desipramine performed better but showing just a non significant trend with heterogeneity present as revealed by the chi-square test (8.6, df=3; p=0.04). One single trial showed imipramine performed better than placebo in terms of clinical response according to patient's self-report. A similar rate of patients remaining in treatment was found for both patients taking desipramine or placebo. Results from one single trial suggest fluoxetine patients on SSRIs are less likely to dropout. Similar results were obtained for trials where patients had additional diagnosis of opioid dependence and/or were in methadone maintenance treatment. Authors' conclusionsThere is no current evidence supporting the clinical use of antidepressants in the treatment of cocaine dependence. Given the high rate of dropouts in this population, clinicians may consider adding psychotherapeutic supportive measures aiming to keep patients in treatment. |