Clinical efficacy of sertraline alone and augmented with gabapentin in recently abstinent cocaine-dependent patients with depressive symptoms

J Clin Psychopharmacol. 2014 Apr;34(2):234-9. doi: 10.1097/JCP.0000000000000062.

Abstract

Background: Cocaine dependence is a major public health problem with no available robustly effective pharmacotherapy. This study's aim was to determine if treatment with sertraline (SERT) or SERT plus gabapentin (GBP) improved treatment retention, depressive symptoms, and/or cocaine use.

Methods: Depressed cocaine-dependent patients (N = 99) were enrolled in a 12-week, double-blind, randomized, placebo (PLA)-controlled, clinical trial and placed in research beds at a residential treatment facility (Recovery Centers of Arkansas). They were randomized by depressive symptom severity and inducted onto 1 of the following while residing at the Recovery Centers of Arkansas: SERT (200 mg/d), SERT (200 mg/d) plus GBP (1200 mg/d), or PLA. Participants transferred to outpatient treatment at the start of their third week, continued receiving study medications or PLA (weeks 3-12), and participated in weekly individual cognitive behavioral therapy. Compliance was facilitated through the use of contingency management procedures. Supervised urine samples were obtained thrice weekly and self-reported mood weekly. At the end of 12 weeks, participants were tapered off the study medication over 5 days and referred to a local treatment program.

Results: Sertraline, but not SERT plus GBP, showed a significantly lower overall percentage of cocaine-positive urine samples compared with that of PLA. A significantly greater percentage of participants experienced relapse in the PLA group (88.9%) compared with that of the SERT group (65.2%). Hamilton depression ratings decreased significantly over time regardless of the treatment group. Retention in treatment did not differ significantly between the treatment groups.

Conclusions: Sertraline plus GBP may not be superior to SERT alone in delaying relapse among abstinent cocaine-dependent individuals undergoing cognitive behavioral therapy.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Amines / administration & dosage
  • Amines / adverse effects
  • Amines / therapeutic use*
  • Cocaine-Related Disorders / complications
  • Cocaine-Related Disorders / drug therapy*
  • Cognitive Behavioral Therapy
  • Combined Modality Therapy
  • Cyclohexanecarboxylic Acids / administration & dosage
  • Cyclohexanecarboxylic Acids / adverse effects
  • Cyclohexanecarboxylic Acids / therapeutic use*
  • Depression / complications
  • Depression / drug therapy*
  • Diagnosis, Dual (Psychiatry)
  • Double-Blind Method
  • Drug Therapy, Combination / adverse effects
  • Female
  • GABA Agonists / administration & dosage
  • GABA Agonists / adverse effects
  • GABA Agonists / therapeutic use
  • Gabapentin
  • Humans
  • Male
  • Medication Adherence
  • Patient Compliance
  • Recurrence
  • Serotonin Uptake Inhibitors / administration & dosage
  • Serotonin Uptake Inhibitors / adverse effects
  • Serotonin Uptake Inhibitors / therapeutic use
  • Sertraline / administration & dosage
  • Sertraline / adverse effects
  • Sertraline / therapeutic use*
  • Young Adult
  • gamma-Aminobutyric Acid / administration & dosage
  • gamma-Aminobutyric Acid / adverse effects
  • gamma-Aminobutyric Acid / therapeutic use*

Substances

  • Amines
  • Cyclohexanecarboxylic Acids
  • GABA Agonists
  • Serotonin Uptake Inhibitors
  • gamma-Aminobutyric Acid
  • Gabapentin
  • Sertraline