Lithium treatment for cocaine abusers with bipolar spectrum disorders

Article Abstract:

It has been hypothesized that lithium, a drug commonly used to treat bipolar spectrum disorders (manic depression), possesses properties that are antagonistic to the pharmacological effects of cocaine. Previous studies have nonetheless failed to find any differences in response to lithium or placebos in treating cocaine abusers, and lithium has been proved to be inferior to treatment with desipramine. To further investigate this, an open trial examining 10 consecutive patients diagnosed with bipolar disorder who also sought treatment for cocaine dependence was performed. Each patient met the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R), criteria for bipolar disorder, and the onset of the disorder preceded drug dependency. The subjects consisted of two women and eight men, and the bipolar disorders were characterized by hypomania, cyclothymia, major depression, which five of the 10 showed signs of. Seven patients had a history of alcohol or other drug dependence, and five had at least one first-degree relative with alcoholism. Lithium treatments were scheduled to last 12 weeks, but six subjects dropped out before completion; eight patients were treated for six or more weeks. A slight, but statistically insignificant, reduction in cocaine use was observed in the patients. The mood of five patients improved over this period, but only one patient had a reduction of cocaine euphoria while on lithium. A reduction of cocaine craving occurred in five of the subjects. In general, the results showed little efficacy of lithium as a cocaine abuse treatment in these bipolar patients. Some of the factors which may help explain these findings are discussed. For example, the high incidence of alcoholism and family history of alcoholism suggests the possibility of misdiagnosis of the affective disorder. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Substance abuse, Cocaine abuse, Bipolar disorder, Lithium, Lithium (Metal)

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Heterogeneity of clinical response during placebo treatment

Article Abstract:

In order to study different patterns of response to placebo among individuals diagnosed with depressive disorder, 144 clinic patients between the ages of 18 and 65 years were randomly assigned one of four treatment trials. The trials were carried out over a six-week period in a double-blind condition, so that until the end of the study, neither the patients nor the experimenters knew which participants were receiving antidepressants or identical looking placebos. Changes over time were measured by a gradient clinical improvement scale. Patients were monitored weekly, and categorized as having an abrupt or gradual onset of improvement. Fifty percent of the 144 patients receiving placebo were rated as demonstrating some improvement. Twenty-three percent improved abruptly and 27 percent improved gradually. Thirty-three percent of all improvements persisted over the six-week study period. The patients who improved gradually tended to show improvement that persisted over time and remained relatively constant throughout the study. Abrupt improvements proved to be very transient. Placebo-related rapid improvement may be related to the anticipation of help and optimism. Abrupt improvement does not resemble a true response to antidepressants, which generally require at least a two-week delay before actual improvement can be seen. Although the gradual improvements in this study more closely resembled a true drug response, the ability to distinguish spontaneous remission from true placebo effects will require further evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Depression, Mental, Depression (Mood disorder), Antidepressants, Placebos

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Imipramine treatment of methadone maintenance patients with affective disorder and illicit drug use

Article Abstract:

Methadone maintenance is a treatment for heroin dependence in which methadone replaces heroin. This type of treatment is controversial because many patients continue to use illicit drugs. It has been suggested that some patients on methadone maintenance programs who continue to use illicit drugs may do so in an attempt to self-medicate symptoms of depression. If these patients were also given antidepressant medication, their mood and their drug use might both improve. In the present investigation, 17 methadone maintenance patients who also met diagnostic criteria for depression were given imipramine, an antidepressant, in addition to methadone. The dosage of imipramine varied due to individual response characteristics, but ranged from 100 to 300 milligrams per day. Subjects were treated for 6 weeks to 11 months. Weekly urine screenings were done to detect illicit drug use; depression was evaluated at baseline and at weeks 6 and 12; and the subjects provided weekly self-reports on drug use. All but two patients reported significant improvement in symptoms of depression during the trial, and nine (53 percent) experienced improved mood and decreased illicit drug use. It is suggested that antidepressant drugs may be an important part of the treatment of patients with more than one diagnosis. This treatment may reduce illicit drug use and possible related risk behavior for HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug addicts, Drug abusers, Affective disorders, Mood disorders, Imipramine

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