DIFFERENTIAL SYMPTOM REDUCTION IN DEPRESSED COCAINE ABUSERS TREATED WITH PSYCHOTHERAPY AND PHARMACOTHERAPY

We evaluated treatment response for depressed versus nondepressed ambu latory cocaine abusers in a 12-week randomized controlled trial of des ipramine and cognitive-behavioral treatment, alone and in combination. Subjects with depressive symptomatology at baseline tended to have be tter retention and better cocaine outcomes compared with nondepressed subjects. Desipramine was an effective antidepressant in this sample a nd was associated with significantly greater reduction in depressive s ymptoms than was placebo; however, desipramine treatment was not assoc iated with greater reductions in cocaine use for either the depressed or euthymic subgroup. Cognitive-behavioral relapse prevention treatmen t was associated with significantly longer periods of consecutive abst inence and better retention compared with supportive clinical manageme nt for the depressed subgroup, but psychotherapy condition did not hav e an effect on depressive symptoms. These data point to differential s ymptom reduction in depressed cocaine addicts and underscore the impor tance of evaluating combined psychotherapy-pharmacotherapy approaches for this population.