Differential symptom reduction in depressed cocaine abusers treated with psychotherapy and pharmacotherapy.
ABSTRACT We evaluated treatment response for depressed versus nondepressed ambulatory cocaine abusers in a 12-week randomized controlled trial of desipramine and cognitive-behavioral treatment, alone and in combination. Subjects with depressive symptomatology at baseline tended to have better retention and better cocaine outcomes compared with nondepressed subjects. Desipramine was an effective antidepressant in this sample and was associated with significantly greater reduction in depressive symptoms than was placebo; however, desipramine treatment was not associated with greater reductions in cocaine use for either the depressed or euthymic subgroup. Cognitive-behavioral relapse prevention treatment was associated with significantly longer periods of consecutive abstinence and better retention compared with supportive clinical management for the depressed subgroup, but psychotherapy condition did not have an effect on depressive symptoms. These data point to differential symptom reduction in depressed cocaine addicts and underscore the importance of evaluating combined psychotherapy-pharmacotherapy approaches for this population.
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ABSTRACT: Although depression is highly comorbid with substance use disorders, little is known about the clinical course and outcomes of methamphetamine (MA) users with depressive symptoms and syndromes. In this study of MA-dependent individuals entering psychosocial treatment, we predicted that (1) depressive symptoms would decline during treatment, an effect that would vary as a function of MA use and (2) depression diagnoses post-treatment would be associated with poorer outcomes. Participants (N = 526) were assessed for depression, substance use, and psychosocial outcomes at baseline, treatment discharge, and 3-year follow-up. Depressive symptoms declined significantly during treatment, an effect that was greatest among those who abstained from MA. Major depression at follow-up was associated with poorer MA use outcomes and impairment across multiple domains of functioning. The findings highlight the relationship of depressive symptoms and diagnoses to treatment outcomes, and suggest a need for further studies of depression in populations using MA.The Journal of nervous and mental disease 05/2009; 197(4):225-31. DOI:10.1097/NMD.0b013e31819db6fe · 1.81 Impact Factor
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ABSTRACT: This paper reviews the literature investigating relapse to alcohol and drug use among individuals dually diagnosed with a substance use and a co-occurring mood, anxiety, schizophrenia-spectrum, or personality disorder. Prevalence rates for each co-occurring set of disorders are discussed, followed by research studies that examine predictors of relapse to substance use within these groups. Relevant conceptual models well-suited to incorporating relapse as an outcome variable, and psychiatric factors both as predictor and outcome variables, are presented. Suggestions for future studies are provided. A priority area is developing and using consistent and well-articulated definitions of relapse across studies. Several diagnostic issues surfaced such as using structured clinical interviews to determine diagnosis (preferably following detoxification from alcohol and/or drugs), separating individuals with only alcohol use disorders from those with alcohol and drug use disorders in analyses, reporting the rates and types of overlap in mental health diagnoses, and conducting analyses that include and exclude multiply disordered individuals. Finally, future studies that focus on isolating predictors of relapse and abstinence could make substantive contributions to improving treatment for individuals with co-occurring substance use and mental health disorders.Clinical Psychology Review 04/2006; 26(2):162-78. DOI:10.1016/j.cpr.2005.11.005 · 7.18 Impact Factor
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ABSTRACT: The aim of this study was to test the hypothesis that desipramine would be an effective treatment in cocaine abusers with current depressive disorders. This was a randomized, 12-week, double-blind, 'placebo-controlled trial of outpatients (N = 111) meeting DSM-III-R criteria for cocaine dependence and major depression or dysthymia (by SCID interview). Participants were treated with desipramine, up to 300 mg per day, or matching placebo. All patients received weekly individual manual-guided relapse prevention therapy. Weekly outcome measures included the Clinical Global Impression Scale, self-reported cocaine use and craving, urine toxicology, and the Hamilton Depression Scale (biweekly). Summary measures of mood and cocaine use outcome were compared between treatment groups with chi2- or t-tests. Dichotomous summary measures of depression response and cocaine response were the primary outcomes. Mixed effect models were also fit to explore the relationship of cocaine use to mood improvement and treatment over weeks in the trial. Desipramine was associated with a higher rate of depression response (51%, 28/55) than placebo (32%, 18/56) (p < 0.05), but treatment groups did not differ in rate of cocaine response. Depression improvement was associated with improvement in cocaine use. Desipramine was associated with more dropouts due to side effects and medical adverse events, while placebo was associated with more dropouts due to psychiatric worsening. Desipramine was an effective treatment for depression among cocaine-dependent patients. Improvement in mood was associated with improvement in cocaine abuse, but a direct effect of medication on cocaine outcome was not clearly established and rates of sustained abstinence were low. Future research should examine newer antidepressant medications with more benign side effect profiles and combinations of behavioral and pharmacological treatments to maximize effects on cocaine use.Drug and Alcohol Dependence 12/2005; 80(2):209-21. DOI:10.1016/j.drugalcdep.2005.03.026 · 3.28 Impact Factor