WITHDRAWN: Antidepressants for cocaine dependence.
BACKGROUND
The 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. Antidepressant pharmacotherapy, by augmenting monoamine levels, may alleviate cocaine abstinence symptomatology, as well as relieving dysphoria and associated craving by general antidepressant action.


OBJECTIVE
To evaluate the efficacy and the acceptability of antidepressants for cocaine dependence


METHODS
We 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CINAHL (1982 to July 2007), SCOPUS (July 2007); reference searching; personal communication; conference abstracts; unpublished trials, ongoing trials, relevant web-sites.


METHODS
All randomised controlled trials and controlled clinical trials which focus on the use of any antidepressants for cocaine dependence


METHODS
The authors independently evaluated the papers, extracted data, rated methodological quality. Doubts were solved throug discussion between all the authors.


RESULTS
18 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.


CONCLUSIONS
There 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.
Silva de Lima
Mauricio
M
Medical, Eli Lilly & Co, Lilly House, Priestley Road, Basingstoke, Hampshire, UK, RG24 9NL.
Farrell
Michael
M
Lima Reisser
Anelise Arl
AA
Soares
Bernardo
B
D000928:Antidepressive Agents / Q000627:therapeutic use*; D019970:Cocaine-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D006801:Humans; D016032:Randomized Controlled Trials as Topic
D000928:Antidepressive Agents