Fluoxetine versus placebo in depressed alcoholic cocaine abusers

To date, few double-blind, placebo-controlled studies with any selective se rotonin reuptake inhibitor (SSRI) antidepressant in pure cocaine abusers or in cocaine abusers with comorbid disorders have been reported. In this stu dy, 17 patients with DSM-III-R diagnoses of major depressive disorder, alco hol dependence, and cocaine abuse were included along with 34 non-cocaine-a busing depressed alcoholics in a pharmacotherapy trial involving the SSRI a ntidepressant fluoxetine. All 51 patients participated in a double-blind, p arallel group study of fluoxetine versus placebo in depressed alcoholics. T he principal focus of this article is the one-third of the depressed alcoho lics who also abused cocaine and how the treatment response of those 17 pat ients compared with that of the 34 depressed alcoholics who did not abuse c ocaine. During the study, no significant difference in treatment outcome wa s noted between the fluoxetine group (N=8) and the placebo group (N=9) for cocaine use, alcohol use, or depressive symptoms. In addition, no significa nt within-group improvement was noted for any of these outcome variables in either of the two treatment groups. Indeed, across the combined sample of 17 depressed alcoholic cocaine abusers, the mean Beck Depression Inventory (BDI) score worsened slightly from 19 to 21 during the course of the study, and 71 percent of the patients continued to complain of suicidal ideations at the end of the study. The 17 cocaine-abusing depressed alcoholics showe d a significantly worse outcome than the 34 non-cocaine abusing depressed a lcoholics on the 24-item Hamilton Rating Scale for Depression (HAM-D) and B DI depression scales and on multiple measures of alcohol consumption. These findings suggest that comorbid cocaine abuse acts as a robust predictor of poor outcome for the drinking and the depressive symptoms of depressed alc oholics.