Venlafaxine treatment of cocaine abusers with depressive disorders

Objective: There appears to be a link between depression and cocaine that i s both complex and elusive. The purpose of this study was to examine the ef fect of venlafaxine, a broad spectrum antidepressant, in the treatment of 1 3 patients who were diagnosed with cocaine dependence and comorbid major de pressive disorder (MDD). Method: The majority of the patients in the study were part of a larger double-blind trial using desipramine. This subgroup c onsisted of people who had failed to respond to desipramine or could not to lerate its side effects. Thirteen patients were enrolled, 10 men and 3 wome n. Of the patients, 11 completed the 12-week study. All of the patients had a Hamilton Depression (HAM-D) score greater than 14 at baseline, and each had used at least $20 worth of cocaine per week in the 4 weeks prior to ent ering the study. In addition, all of the patients received weekly relapse p revention therapy throughout the study. The median dose of venlafaxine was 150 mg/day. Results: The 11 patients who completed the study had significan t reductions in mood symptoms by the end of the study. The average total HA M-D score at baseline was 18.0 +/- 3.2; at Week 2, it was 1.9 +/- 0.94; and at the end of the study, it was 1.4 +/- 1.8. The majority of patients repo rted reductions of cocaine use short of abstinence. All subjects reported a greater than 75% reduction in cocaine use compared to baseline. There were no serious side effects. Conclusions: The results of this small study indi cate that venlafaxine may be a safe, well-tolerated, rapidly acting, and ef fective treatment for patients with a dual diagnosis of depression and coca ine dependence.