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Dysregulation of Diurnal Cortisol Secretion Affects Abstinence Induction during a Lead-in Period of a Clinical Trial for Depressed Cocaine-Dependent Patients

Authors

  • Wilfrid Noel Raby MD, PhD,

    Corresponding author
    1. Division on Substance Abuse, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York
    • Address correspondence to Dr. Raby, Division on Substance Abuse, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032. E-mail: rabywil@nyspi.columbia.edu.

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  • Lisa SanFilippo BA,

    1. Division on Substance Abuse, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York
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  • Martina Pavlicova PhD,

    1. Department of Biostatistics, Columbia University, New York, New York
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  • Kenneth M. Carpenter PhD,

    1. Division on Substance Abuse, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York
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  • Andrew Glass MS,

    1. Division on Substance Abuse, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York
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  • Chukwudi Onyemekwu BA,

    1. Division on Substance Abuse, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York
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  • Eric Roginek BS,

    1. Division on Substance Abuse, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York
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  • Edward V. Nunes MD

    1. Division on Substance Abuse, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York
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Abstract

Background and Objective

Hypothesizing that stress dysregulation may worsen cocaine dependence, we investigated the effect of diurnal cortisol secretion profile, suppression of cortisol secretion, and total cortisol secretion on retention, abstinence-based voucher earnings, days of cravings, and mood status of participants at the end of a 2-week medication-free lead-in prior to randomization in a clinical trial of mirtazapine (60 mg vs. placebo) for depressed cocaine-dependent patients.

Methods

We measured saliva cortisol levels at 9 AM, 2 PM, and 5 PM on the first two consecutive days of a 2-week medication-free lead-in period. Results from saliva samples were used to estimate the total daily level of cortisol, the diurnal profile of secretion (typical vs. atypical), and response to dexamethasone suppression (.1 mg). Seventy-seven patients collected saliva samples at baseline, and 65 (85%) were suitable for profile analysis.

Results

Patients with typical profiles (52%) collected significantly more abstinence-based voucher earnings during the lead-in (U = 299.50, p = .025). Diurnal secretion profile did not significantly affect mood status, days of craving, or retention. There were no significant effects of suppression of cortisol secretion or of total cortisol levels on any outcome measures.

Conclusion

In a subgroup of cocaine-dependent patients, deviation of cortisol secretion away from the homeostatic diurnal pattern was associated with reduced success at achieving early abstinence, an important determinant of treatment success. (Am J Addict 2014;23:1–6)

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