title: Treatment of cannabis dependence using escitalopram in combination with cognitive-behavior therapy: a double-blind placebo-controlled study.
abstract: BACKGROUND
  Cannabis is the most frequently used illegal substance in the United States and Europe. There is a dramatic increase in the demand for treatment for cannabis dependence. Cannabis users frequently have co-morbid mood symptoms, especially depression and anxiety, and regular cannabis users may self-medicate for such symptoms.
  
  
  OBJECTIVE
  We report a double-blind, placebo-controlled treatment study, for the prevention of cannabis use in cannabis-dependent individuals.
  
  
  METHODS
  Regular cannabis-dependent users (n = 52) were treated for 9 weeks with weekly cognitive-behavior and motivation-enhancement therapy sessions together with escitalopram 10 mg/day. Urine samples were collected to monitor delta-9 tetrahydrocannabinol (THC) during treatment and questionnaires were administered to assess anxiety and depression.
  
  
  RESULTS
  We observed a high rate of dropout (50%) during the 9-week treatment program. Fifty-two patients were included in the intention-to-treat analysis. Of these, ten (19%) remained abstinent after 9 weeks of treatment as indicated by negative urine samples for THC. Escitalopram provided no advantage over placebo in either abstinence rates from cannabis or anxiety and depression scores during the withdrawal and abstinent periods.
  
  
  CONCLUSIONS
  Escitalopram treatment does not provide an additional benefit either for achieving abstinence, or for the treatment of the cannabis withdrawal syndrome. Due to limitations of our study, namely, a high dropout rate and effects of low abstinence rates on measures of anxiety, depression and withdrawal, it is premature to conclude that selective serotonin reuptake inhibitors are not effective for treatment of the cannabis withdrawal syndrome.
authors.affiliation: Psychiatric Department and.
authors.forename: A M
authors.initials: AM
authors.lastname: Weinstein
authors.forename: H
authors.initials: H
authors.lastname: Miller
authors.forename: I
authors.initials: I
authors.lastname: Bluvstein
authors.forename: E
authors.initials: E
authors.lastname: Rapoport
authors.forename: S
authors.initials: S
authors.lastname: Schreiber
authors.forename: R
authors.initials: R
authors.lastname: Bar-Hamburger
authors.forename: M
authors.initials: M
authors.lastname: Bloch
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications / Q000188:drug therapy; D015283:Citalopram / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003863:Depression / Q000150:complications / Q000188:drug therapy; D004311:Double-Blind Method; D013759:Dronabinol / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000150:complications / Q000188:drug therapy* / Q000628:therapy* / Q000652:urine; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy / Q000517:prevention & control; D055815:Young Adult
chemical_list: D015283:Citalopram; D013759:Dronabinol; D017367:Selective Serotonin Reuptake Inhibitors