Article

Treatment of cocaine dependence and depression

Department of Psychiatry, Yale University School of Medicine, New Haven, and Veterans Affairs Connecticut Healthcare, West Haven, Connecticut 06516, USA.
Biological Psychiatry (Impact Factor: 10.25). 12/2004; 56(10):803-9. DOI: 10.1016/j.biopsych.2004.05.009
Source: PubMed

ABSTRACT In common with all other classes of substance use disorders, cocaine dependence has been shown to be strongly associated with depression by community and clinical surveys. Diagnosing depression in cocaine abusers can be challenging because it is difficult to distinguish transient symptoms caused by cocaine from enduring depression syndromes. Nonetheless, both "substance-induced" and "independent" depression syndromes require clinical attention, especially when symptoms have been persistent and severe before entering treatment. Use of antidepressant medications for combined cocaine dependence and depression is supported by a preponderance of evidence from 4 randomized clinical trials (RCTs) that prospectively targeted both depression and cocaine dependence and 7 RCTs in which a post hoc analyses demonstrated efficacy in the subgroup of cocaine abusers with comorbid depression. Notably, most negative studies have evaluated SSRIs while positive studies have used agents such as desipramine or buproprion. A substantial clinical trials literature supports the efficacy of behavioral treatments for general populations of cocaine abusers and of patients with depression but few studies have addressed patients with both disorders. Treatment development and research are needed on models of care that truly integrate strategies for addressing both cocaine use and depression. Recent advances have paved the way for a new generation of research. These include validation of efficacious cocaine treatments, improved diagnostic methods, organization of the Clinical Trials Network and development of guidelines for managing methodological challenges posed by high rates of current medication use and polysubstance abuse in treatment entering cocaine abusers.

0 Followers
 · 
60 Views
  • Source
    • "Es decir, los resultados difieren en función de la composición de las series (tipos de población, vías de administración, etc.) y de la metodología empleada (instrumentos de medida, tiempo transcurrido desde la abstinencia , entrenamiento en el diagnóstico psicopatológico de los entrevistadores, etc.). En cualquier caso, y considerando los datos de forma global, podemos concluir que la prevalencia de comorbilidad psicopatológica entre pacientes consumidores de cocaína, es muy elevada (Rounsaville, 2004; Schuckit, 2006; Weiser et al., 2003). Por lo tanto, es importante conocer qué tipo de trastorno presenta cada persona y las características del mismo. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cocaine addiction is a growing health problem and among its complications highlights the high prevalence of mental disorders co-occurring with abuse and dependence. This psychopathological comorbidity varies according to the time of consumption and the age of the patient. Early detection of psychopathological disorders associated with drug consumption is necessary to optimize health care and to improve the prognosis. The main aim of the present study was to estimate the prevalence and characteristics of psychopathological comorbidity in a population of subjects seeking outpatient treatment for cocaine use. We recruited 110 subjects using cocaine by nasal insufflations evaluated with the PRISM (Psychiatric Research Interview for Substance and Mental Disorders), a semi-structured diagnostic interview that differentiates primary mental disorders from those induced by the drug. This population presented 86.4% male and had a mean age of 36.5. They displayed a pathological use of cocaine of 7 years and the presence of psychopathology was associated with a higher number of DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders- IV-TR) criteria for substance dependence. The lifetime prevalence of some psychopathological comorbidity was 61.8%, highlighting mood disorders (34.5%), followed by anxiety disorders (22.7%) and psychotic disorders (15.5%). About 20% showed antisocial personality disorder and 21% borderline personality disorder. From among mood and psychotic disorders, the induced disorders were more frequent, while the primary disorders were more prevalent in anxiety.
    Adicciones 02/2014; 26(1):15-26. · 1.17 Impact Factor
  • Source
    • "Es decir, los resultados difieren en función de la composición de las series (tipos de población, vías de administración, etc.) y de la metodología empleada (instrumentos de medida, tiempo transcurrido desde la abstinencia , entrenamiento en el diagnóstico psicopatológico de los entrevistadores, etc.). En cualquier caso, y considerando los datos de forma global, podemos concluir que la prevalencia de comorbilidad psicopatológica entre pacientes consumidores de cocaína, es muy elevada (Rounsaville, 2004; Schuckit, 2006; Weiser et al., 2003). Por lo tanto, es importante conocer qué tipo de trastorno presenta cada persona y las características del mismo. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cocaine addiction is a growing health problem and among its complications highlights the high prevalence of mental disorders co-occurring with abuse and dependence. This psychopathological comorbidity varies according to the time of consumption and the age of the patient. Early detection of psychopathological disorders associated with drug consumption is necessary to optimize health care and to improve the prognosis. The main aim of the present study was to estimate the prevalence and characteristics of psychopathological comorbidity in a population of subjects seeking outpatient treatment for cocaine use. We recruited 110 subjects using cocaine by nasal insufflations evaluated with the PRISM (Psychiatric Research Interview for Substance and Mental Disorders), a semi-structured diagnostic interview that differentiates primary mental disorders from those induced by the drug. This population presented 86.4% male and had a mean age of 36.5. They displayed a pathological use of cocaine of 7 years and the presence of psychopathology was associated with a higher number of DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders- IV-TR) criteria for substance dependence. The lifetime prevalence of some psychopathological comorbidity was 61.8%, highlighting mood disorders (34.5%), followed by anxiety disorders (22.7%) and psychotic disorders (15.5%). About 20% showed antisocial personality disorder and 21% borderline personality disorder. From among mood and psychotic disorders, the induced disorders were more frequent, while the primary disorders were more prevalent in anxiety. Key words: comorbidity, psychopathology, cocaine, abuse, dependence.
    Adicciones 01/2014; 26(1):15-26. · 1.17 Impact Factor
  • Source
    • "The likelihood of substance abuse/dependence disorders and depression to occur together in the same individuals is about 5 times greater than would be expected by the prevalence of each disorder alone (Rounsaville, 2004; Volkow, 2004). According to self-medication hypothesis, people use drugs to enhance mood and alleviate emotional distress (Khantzian, 1985). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Stress increases vulnerability to addiction while drugs of abuse impair coping responses to predispose to depression. Preclinical research shows that stress exposure augments locomotor sensitization effects of drugs of abuse and impairs behavioral tolerance to repeated stress. The present study investigates relationship between behavioral tolerance to repeated immobilization stress and apomorphine-induced sensitization. Apomorphine was injected either before exposure or after the termination of immobilization, daily for 5days, to monitor drug-induced behavioral sensitization and tolerance in immobilization stress-induced anorexia. We find that apomorphine-induced sensitization is enhanced and tolerance to repeated immobilization impaired if the drug is administered before exposure to stress episode. Conversely, apomorphine-induced sensitization is inhibited and adaptation to stress facilitated if the drug is administered after the termination of stress episode. It shows that apomorphine if experienced during stress produces greater sensitization and impairs stress tolerance. Conversely, sensitization effects of apomorphine are blocked and tolerance to stress facilitated in animals receiving drug after the termination of stress episode. It is suggested that additive effects of stress and apomorphine on mesocorticolimbic dopamine neurotransmission and 5-HT-1A influences on dopamine neurotransmission may have a role in the modulation of apomorphine sensitization and tolerance to repeated immobilization stress. The results may help develop potential pharmacotherapies when substance abuse/ dependence disorder and depression occur together.
    Pharmacology Biochemistry and Behavior 09/2013; 112. DOI:10.1016/j.pbb.2013.09.011 · 2.82 Impact Factor
Show more