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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An adolescent who was simultaneously dependent on cocaine and treated for attention-deficit hyperactivity disorder (ADHD) with dexedrine developed symptoms of severe depression followed by suicidal behavior. The patient was treated for cocaine craving, depression, and ADHD with desipramine on an inpatient adolescent unit for substance abusers with comorbid psychiatric disorder. The Minnesota Cocaine Craving Scale was used to monitor the cocaine craving. Issues about the strategies for the treatment of cocaine craving and the stimulant treatment/abuse dilemma are discussed with a special emphasis on comorbidity in adolescent substance abusers. Suicidal behavior related to cocaine abuse and craving and the application of the cocaine abstinence three phase model to an inpatient setting are illuminated.
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PMID:Desipramine facilitation of cocaine abstinence in an adolescent. 131 57

Three types were found in a cluster analysis of scores on the Minnesota Multiphasic Personality Inventory (MMPI) of 100 men voluntarily presenting for treatment of cocaine abuse. Type 1 (n = 59) had a mean MMPI profile consistent with the hypothesized grouping of persons who self-medicate with cocaine as a means of overcoming depression. The relatively normal mean MMPI profile obtained by Type 2 (n = 37) suggested little indication of significant psychopathology. Type 3's (n = 4) mean MMPI profile suggested either severe disturbance or profile invalidity. Types were found to differ in the nature of drug use, reactions to cocaine, education level, and social class, but not on the scales of the Adjective Check List.
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PMID:An MMPI typology of cocaine abusers. 131 58

The Halikas-Crosby Drug Impairment Rating Scale for Cocaine (HAL DIRS-C) is designed to measure improvement in drug treatment through interval assessment of impact of cocaine use on daily functioning, relationships with other people, other alcohol and drug use, cocaine withdrawal symptoms, adverse effects associated with cocaine use, and personal outlook over the previous week. The scale is a 25-item clinical rating scale administered in the context of a semistructured interview (modeled after and similar to the Hamilton Rating Scale for Depression). The HAL DIRS-C was administered weekly to 147 subjects participating in a 12-week, double-blind medication trial with a psychosocial treatment component. Without breaking the pharmacologic blind, the HAL DIRS-C score was found to be significantly related to study retention, ongoing psychosocial treatment participation, urinalysis results, and other measures of outcome. The results support the validity of the HAL DIRS-C as a standardized measure of improvement or outcome in clinical research involving the treatment of cocaine abuse.
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PMID:The convergent validity of the Drug Impairment Rating Scale for Cocaine. 148 Jul 36

The dependence syndrome concept, developed for alcohol and extended to other abused substances, postulates that its elements form a continuum of severity. Dependence severity should predict treatment success if this concept has predictive validity. Because most studies that examined this aspect of validity used alcoholic populations, we undertook the present 1-year follow-up of 48 opiate addicts to investigate whether dependence severity predicted program retention, treatment compliance, and psychological functioning. We also controlled demography, withdrawal severity, and substance use frequency. The best predictor of program retention was the addicts' rating of substance use frequency. Severity of opiate dependence predicted program retention in White addicts only. For non-White opiate addicts, concurrent depression and cocaine abuse had much greater association with program retention compared to dependence severity.
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PMID:The predictive validity of the dependence syndrome in opiate abusers. 156 12

Pharmacotherapy response in depressed (n = 20) vs. nondepressed (n = 74) cocaine-abusing methadone maintenance patients was compared in a 12-week, randomized, double-blind trial using amantadine at 300 mg daily (n = 33), desipramine at 150 mg daily (n = 30), and placebo (n = 31). Starting in Week 3, the depressed patients on medications reported significantly less cocaine usage than the depressed patients who received placebo. By Week 10, the medicated depressed patients (in treatment) reported a 96 percent decrease in cocaine usage and a 68 percent decrease in cocaine craving. During the last 2 weeks of treatment, 42 percent of the urine toxicologies of the medicated depressed patients were cocaine free, compared with only 6 percent of the placebo depressed patients. Also, the placebo nondepressed patients had significantly better treatment outcome compared with the placebo depressed patients. Thus, depression appears to be an important predictor of poor treatment outcome with relapse prevention therapy alone and of good response to cocaine abuse treatment with medication.
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PMID:Depression as a prognostic factor for pharmacological treatment of cocaine dependence. 177 8

A cohort sample of 93 addicts admitted to methadone maintenance in four clinics was followed-up for one year to determine change, and predictors of change, in cocaine use. Any use of cocaine in the preceding month decreased from 84% of subjects at admission to 66% at follow-up, and mean days of cocaine use per month for those still using decreased from 16 days to 9 days. Any drug injection in the preceding month decreased from 100% of subjects at admission to 39% at follow-up, among those remaining in the program. Continuance/cessation of cocaine use was not associated with program retention, but cocaine users were more likely to be administratively discharged. Reported symptoms of depression and speedballing at admission were significant predictors of continuance/cessation of cocaine use at follow-up. State-of-the-art cocaine abuse treatment, with attention to treatment of depression, would enhance the value of methadone maintenance for patients with dual heroin/cocaine addiction.
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PMID:Changes in cocaine use after entry to methadone treatment. 177 98

Ten male patients with chronic cocaine abuse received a single dose of the dopamine agonist apomorphine. Self-ratings of cocaine craving, depression, and anxiety decreased in response to apomorphine. Neuroendocrine response was consistent with central dopaminergic stimulation. Patients in the "craving" phase of the cocaine abuse cycle differed in behavioral but not neuroendocrine response to apomorphine from patients in the "crash" phase. Decrease in cocaine craving correlated with decrease in plasma homovanillic acid (pHVA). Total cocaine consumption correlated negatively with baseline prolactin and pHVA levels and inversely with peak change in prolactin following apomorphine. Patients had blunted neuroendocrine response to apomorphine in comparison to historical normal controls. Implications for the "dopamine" hypothesis of cocaine abuse are discussed.
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PMID:Dopaminergic sensitivity and cocaine abuse: response to apomorphine. 224 93

Plasma concentrations of desipramine (DMI) and its 2-hydroxy metabolite (OHDMI) were compared among 72 patients being treated with desipramine for either depression (n = 39) or cocaine abuse (n = 33). Eleven cocaine abusers who were concurrently maintained on methadone had a significantly lower ratio of DMI dose to plasma concentration (0.9) than the depressives (2.2) or nonmethadone cocaine abusers (2.0). Their OHDMI/DMI ratios were significantly lower (0.19) than for either the other 22 cocaine abusers (0.39) or the depressed (0.50) patients. This difference was not due to DMI dosage. Although the underlying mechanism cannot be determined from these plasma studies, possible reduced hydroxylation of DMI in methadone patients suggests the need for DMI plasma monitoring.
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PMID:Evidence for altered desipramine disposition in methadone-maintained patients treated for cocaine abuse. 228 30

Blood pressure and heart rate often increase during cocaine intoxication, but the mechanisms of these cardiovascular responses are poorly understood. The most often suggested theories are central nervous system mechanisms involving the blockade of neuronal transmitter uptake. Cocaine also has potent local anesthetic properties, and in this study we tested the possible role of peripheral actions of cocaine at baroreceptor afferents. Single fiber baroreceptors were recorded using an in vitro preparation of the rat aortic arch. Diameter, pressure, and baroreceptor discharge were recorded. Cocaine perfused through the lumen of the aortic arch at a suprathreshold pressure reduced baroreceptor discharge within 90 s of entering the lumen of the aorta. Slow ramps of pressure elicited complete pressure- and diameter-discharge curves every 5 min. Beginning at about 1 microM, cocaine inhibited baroreceptor function; threshold increased, the maximum discharge decreased, and at 100 microM cocaine, all discharge ceased. The vasodilator nitroprusside or the alpha 1-adrenoreceptor antagonist prazosin did not affect baroreceptor responses to cocaine. In in vivo tests in rabbits, cocaine that perfused through a vascularly isolated carotid sinus reduced the slope of the baroreflex relationship between carotid sinus pressure and systemic mean arterial pressure. Significant depression of baroreceptor function was found at concentrations similar to the plasma cocaine levels measured in clinical studies. The local anesthetic properties of cocaine may be involved in baroreceptor effects. Our studies suggest a possible contributing role of a new site of action of cocaine outside the central nervous system. Compromise of baroreceptor reflexes could facilitate the development of serious cardiovascular complications associated with cocaine abuse.
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PMID:Cocaine inhibits baroreflex control of blood pressure by actions at arterial baroreceptors. 233 Oct 13

Using structured interviews and the SCL-90R, study was made of the behaviors of 29 applicants to a residential treatment program for cocaine abuse who had been placed on the program's waiting list for periods ranging from 1 to 6 months. It was hypothesized that applicants waiting treatment for 3 months or less (N = 16) would be more likely to view themselves as treatment candidates and would show behaviors different from those waiting 4-6 months (N = 13). Being on the waiting list a longer period was associated with greater evidence of criminal justice involvement, but with few other differences. Nearly half the total sample (48.3%) reported having significantly reduced drug use in association with their applying for treatment, but most applicants (58.6%) were pessimistic about their long-term capacity to remain free of drug-related difficulty. The pattern of SCL-90R scores for all subjects suggested significant psychiatric symptoms, including depression. Nonetheless, a majority of all applicants (51.7%) reported themselves as having become less interested in entering treatment. Nearly all applicants reported high levels of encouragement for their decision to enter treatment from persons with whom they were living and about half reported encouragement from friends. Of the 23 applicants who were IV drug users, 10 (41.7%) reported knowing someone who had contracted AIDS, 87.0% reported having changed behaviors--chiefly needle sharing--to reduce the risk of infection, and 69.6% reported having obtained HIV testing. The difficulty encountered in locating a random sample of applicants suggests the problem of maintaining a useful waiting list for treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The functioning of individuals on a drug abuse treatment waiting list. 276 83


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