Sertraline delays relapse in recently abstinent cocaine-dependent patients with depressive symptoms
Article first published online: 10 OCT 2011
© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction
Volume 107, Issue 1, pages 131–141, January 2012
How to Cite
Oliveto, A., Poling, J., Mancino, M. J., Williams, D. K., Thostenson, J., Pruzinsky, R., Gonsai, K., Sofuoglu, M., Gonzalez, G., Tripathi, S. and Kosten, T. R. (2012), Sertraline delays relapse in recently abstinent cocaine-dependent patients with depressive symptoms. Addiction, 107: 131–141. doi: 10.1111/j.1360-0443.2011.03552.x
- Issue published online: 12 DEC 2011
- Article first published online: 10 OCT 2011
- Accepted manuscript online: 24 JUN 2011 06:40AM EST
- Submitted 16 November 2010; initial review completed 3 January 2011; final version accepted 17 June 2011
- Cocaine dependence;
- cognitive behavioral therapy;
- placebo control;
- randomized clinical trial;
- relapse prevention;
Aims Whether the selective serotonin re-uptake inhibitor sertraline at 200 mg/day delays relapse in recently abstinent cocaine-dependent individuals.
Design The study involved a 12-week, double-blind, placebo-controlled clinical trial with 2-week residential stay followed by 10-week out-patient participation.
Setting Veterans Affairs residential unit and out-patient treatment research program.
Participants Cocaine-dependent volunteers (n = 86) with depressive symptoms (Hamilton score > 15), but otherwise no major psychiatric or medical disorder or contraindication to sertraline.
Measurements Participants were housed on a drug-free residential unit (weeks 1–2) and randomized to receive sertraline or placebo. Participants then participated on an out-patient basis during weeks 3–12 while continuing to receive study medication. Patients participated in a day substance abuse/day treatment program during weeks 1–3 and underwent weekly cognitive behavioral therapy during weeks 4–12. The primary outcome measure was thrice-weekly urine results and the secondary measure was Hamilton Depression scores.
Findings Pre-hoc analyses were performed on those who participated beyond week 2. Generally, no group differences in retention or baseline characteristics occurred. Sertraline patients showed a trend towards longer time before their first cocaine-positive urine (‘lapse’, χ2 = 3.67, P = 0.056), went significantly longer before having two consecutive urine samples positive for cocaine (‘relapse’, χ2 = 4.03, P = 0.04) and showed significantly more days to lapse (26.1 ± 16.7 versus 13.2 ± 10.5; Z = 2.89, P = 0.004) and relapse (21.3 ± 10.8 versus 32.3 ± 14.9; Z = 2.25, P = 0.02). Depression scores decreased over time (F = 43.43, P < 0.0001), but did not differ between groups (F = 0.09, P = 0.77).
Conclusions Sertraline delays time to relapse relative to placebo in cocaine-dependent patients who initially achieve at least 2 weeks of abstinence.