A randomized double-blind, placebo-controlled trial of venlafaxine-extended release for co-occurring cannabis dependence and depressive disorders

Authors

  • Frances R. Levin,

    Corresponding author
    1. Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
    • New York State Psychiatric Institute, Division of Substance Abuse, New York, NY, USA
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  • John Mariani,

    1. New York State Psychiatric Institute, Division of Substance Abuse, New York, NY, USA
    2. Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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  • Daniel J. Brooks,

    1. New York State Psychiatric Institute, Division of Substance Abuse, New York, NY, USA
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  • Martina Pavlicova,

    1. Department of Biostatistics, Columbia University, New York, NY, USA
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  • Edward V. Nunes,

    1. New York State Psychiatric Institute, Division of Substance Abuse, New York, NY, USA
    2. Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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  • Vito Agosti,

    1. Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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  • Adam Bisaga,

    1. New York State Psychiatric Institute, Division of Substance Abuse, New York, NY, USA
    2. Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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  • Maria A. Sullivan,

    1. New York State Psychiatric Institute, Division of Substance Abuse, New York, NY, USA
    2. Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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  • Kenneth M. Carpenter

    1. New York State Psychiatric Institute, Division of Substance Abuse, New York, NY, USA
    2. Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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Correspondence to: Frances R. Levin, New York State Psychiatric Institute, Division of Substance Abuse, 1051 Riverside Drive, Unit 66, New York, NY 10032, USA. E-mail: frl2@columbia.edu

Abstract

Aim

To evaluate whether venlafaxine-extended release (VEN-XR) is an effective treatment for cannabis dependence with concurrent depressive disorders.

Design

This was a randomized, 12-week, double-blind, placebo-controlled trial of out-patients (n = 103) with DSM-IV cannabis dependence and major depressive disorder or dysthymia. Participants received up to 375 mg VEN-XR on a fixed-flexible schedule or placebo. All patients received weekly individual cognitive–behavioral psychotherapy that primarily targeted marijuana use.

Settings

The trial was conducted at two university research centers in the United States.

Participants

One hundred and three cannabis-dependent adults participated in the trial.

Measurements

The primary outcome measures were (i) abstinence from marijuana defined as at least two consecutive urine-confirmed abstinent weeks and (ii) improvement in depressive symptoms based on the Hamilton Depression Rating Scale.

Findings

The proportion of patients achieving a clinically significant mood improvement (50% decrease in Hamilton Depression score from baseline) was high and did not differ between groups receiving VEN-XR (63%) and placebo (69%) (χ12 = 0.48, P = 0.49). The proportion of patients achieving abstinence was low overall, but was significantly worse on VEN-XR (11.8%) compared to placebo (36.5%) (χ12 = 7.46, P < 0.01; odds ratio = 4.51, 95% confidence interval: 1.53, 13.3). Mood improvement was associated with reduction in marijuana use in the placebo group (F1,179 = 30.49, P < 0.01), but not the VEN-XR group (F1,186 = 0.02, P = 0.89).

Conclusions

For depressed, cannabis-dependent patients, venlafaxine-extended release does not appear to be effective at reducing depression and may lead to an increase in cannabis use.

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