Sertraline delays relapse in recently abstinent cocaine-dependent patients with depressive symptoms

Addiction. 2012 Jan;107(1):131-41. doi: 10.1111/j.1360-0443.2011.03552.x. Epub 2011 Oct 10.

Abstract

Aims: Whether the selective serotonin re-uptake inhibitor sertraline at 200 mg/day delays relapse in recently abstinent cocaine-dependent individuals.

Design: The study involved a 12-week, double-blind, placebo-controlled clinical trial with 2-week residential stay followed by 10-week out-patient participation.

Setting: Veterans Affairs residential unit and out-patient treatment research program.

Participants: Cocaine-dependent volunteers (n = 86) with depressive symptoms (Hamilton score > 15), but otherwise no major psychiatric or medical disorder or contraindication to sertraline.

Measurements: Participants were housed on a drug-free residential unit (weeks 1-2) and randomized to receive sertraline or placebo. Participants then participated on an out-patient basis during weeks 3-12 while continuing to receive study medication. Patients participated in a day substance abuse/day treatment program during weeks 1-3 and underwent weekly cognitive behavioral therapy during weeks 4-12. The primary outcome measure was thrice-weekly urine results and the secondary measure was Hamilton Depression scores.

Findings: Pre-hoc analyses were performed on those who participated beyond week 2. Generally, no group differences in retention or baseline characteristics occurred. Sertraline patients showed a trend towards longer time before their first cocaine-positive urine ('lapse', χ(2) = 3.67, P = 0.056), went significantly longer before having two consecutive urine samples positive for cocaine ('relapse', χ(2) = 4.03, P = 0.04) and showed significantly more days to lapse (26.1 ± 16.7 versus 13.2 ± 10.5; Z = 2.89, P = 0.004) and relapse (21.3 ± 10.8 versus 32.3 ± 14.9; Z = 2.25, P = 0.02). Depression scores decreased over time (F = 43.43, P < 0.0001), but did not differ between groups (F = 0.09, P = 0.77).

Conclusions: Sertraline delays time to relapse relative to placebo in cocaine-dependent patients who initially achieve at least 2 weeks of abstinence.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Ambulatory Care
  • Cocaine-Related Disorders / complications
  • Cocaine-Related Disorders / drug therapy*
  • Cocaine-Related Disorders / urine
  • Cognitive Behavioral Therapy
  • Depression / complications
  • Depression / drug therapy*
  • Double-Blind Method
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Placebos
  • Psychiatric Status Rating Scales
  • Secondary Prevention
  • Serotonin Uptake Inhibitors / administration & dosage
  • Serotonin Uptake Inhibitors / pharmacology
  • Serotonin Uptake Inhibitors / therapeutic use*
  • Sertraline / administration & dosage
  • Sertraline / pharmacology
  • Sertraline / therapeutic use*
  • Severity of Illness Index
  • Time Factors
  • Young Adult

Substances

  • Placebos
  • Serotonin Uptake Inhibitors
  • Sertraline