IMIPRAMINE TREATMENT OF COCAINE ABUSE - POSSIBLE BOUNDARIES OF EFFICACY

A 12-week placebo-controlled, randomized clinical trial was undertaken to evaluate imipramine as a treatment for cocaine abuse, and to exami ne whether its effect may be limited to subgroups defined by route of use or by diagnosis of depression. One-hundred thirteen patients were randomized, stratified by route of use and depression. All patients re ceived weekly individual counseling. Compared to placebo the imipramin e group showed greater reductions in cocaine craving, cocaine euphoria , and depression, but the effect of imipramine on cocaine use was less clear. A favorable response, defined as at least 3 consecutive, urine -confirmed, cocaine-free weeks was achieved by 19% (11/59) of patients on imipramine compared to 7% (4/54) on placebo (P < 0.09). The imipra mine effect was greater among nasal users - 33% (9/27) response on imi pramine vs. 5% (1/22) on placebo (P < 0.02). Response was also more fr equent, but not significantly so, among depressed users on imipramine (26%, 10/38) than on placebo (13%, 4/31) (P < 0.19). Response rates we re low in intravenous and freebase users and those without depression. Considered together with. the literature on desipramine, these data s uggest tricyclic antidepressants are not promising as a mainstay of tr eatment for unselected cocaine abusers, However, tricyclics may be use ful for selected cocaine abusers with comorbid depression or intranasa l use, or in conjunction with a more potent psychosocial intervention.