Imipramine Treatment of Opiate-Dependent Patients With Depressive Disorders

Nunes, Edward V.; Quitkin, Frederic M.; Donovan, Stephen J.; Deliyannides, Deborah A.; Ocepek‐Welikson, Katja; Koenig, Teresa; Brady, Ronald; McGrath, Patrick J.; Woody, George

doi:10.1001/archpsyc.55.2.153

Cited by 152 publications

(93 citation statements)

References 58 publications

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“…If, as suggested, the affective symptoms of withdrawal are critical to the development of drug dependence and in causing relapse during the early stages of abstinence Markou et al 1998), then reversal of such symptoms with serotonergic antidepressant treatments may reduce the probability of relapse. Indeed, there is evidence that antidepressant treatment results in improvement of mood and reduction of drug use in depressed cocaine, opiate and nicotine abusers (for reviews, see Hughes et al 2000;Kosten et al 1998;Markou et al 1998;Nunes et al 1998;Watkins et al 2000a).…”

Section: Discussionmentioning

confidence: 99%

Fluoxetine Combined with a Serotonin-1A Receptor Antagonist Reversed Reward Deficits Observed during Nicotine and Amphetamine Withdrawal in Rats

Harrison

Liem

Markou

2001

Neuropsychopharmacology

158

126

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Cessation of chronic nicotine or amphetamine administration precipitates withdrawal syndromes characterized by affective symptoms, including "diminished interest or pleasure" in rewarding stimuli (i.e., anhedonia) (American Psychiatric Association 1994;Covey et al. 1998;Glassman 1993;Hughes 1992). Interestingly, the symptom of "diminished interest or pleasure" is not only a symptom of drug withdrawal, but also a core symptom of depression and a negative symptom of schizophrenia (American Psychiatric Association 1994;Markou et al. 1998). Brain reward threshold elevation is an operational measure of this symptom because it reflects diminished sensitivity to rewarding electrical stimuli. In rats, withdrawal from drugs of abuse belonging to diverse pharmacological classes, such as nicotine (Epping-Jordan et al. 1998 Watkins et al. 2000b), amphetamine Zacharko 1980a, 1980b;Kokkinidis et al. 1980Kokkinidis et al. , 1986 Barrett 1976, 1980;Lin et al. 1999Lin et al. , 2000Paterson et al. 2000;Wise and Munn 1995), cocaine (Baldo et al. 1999;Kokkinidis and McCarter 1990; Koob 1991, 1992a;Markou et al. 1992) morphine (Schulteis et al. 1994) and ethanol (Schulteis et al. 1995) elevated brain stimulation reward thresholds.In addition to the affective aspects of drug withdrawal reflected in threshold elevations, nicotine, opiate, or ethanol withdrawal also lead to alterations in a set of behaviors termed somatic signs. In the case of nicotine, these somatic signs are primarily gasps, writhes, eye blinks, and ptosis (Epping-Jordan et al. 1998;Hildebrand et al. 1997Hildebrand et al. , 1999Malin et al. 1992). It is unlikely that these somatic signs in the rat reflect the affective component of drug withdrawal. Nevertheless, the study of both threshold elevations and somatic signs permits the investigation of the effects of manipulations on the various aspects of withdrawal.Based on evidence demonstrating the efficacy of serotonergic antidepressant treatments, reduced cerebrospinal fluid levels of serotonin metabolites, endocrine measures reflecting reduced serotonergic neurotransmission and the exacerbation of depressive symptomatology seen after serotonin (5-HT) depletion in depressed individuals, it is hypothesized that reduced serotonergic neurotransmission underlies at least some aspects or some subtypes of non-drug-induced depressions (for reviews, see Caldecott-Hazard et al. 1991; CaldecottHazard and Schneider 1992;Heninger et al. 1996;Markou et al. 1998;Meltzer and Lowy 1988;Willner 1985). The purpose of the present study was to test the hypothesis that reduced serotonergic neurotransmission mediates some of the affective aspects, not only of non-drug-induced depressions, but also of druginduced depressions. Thus, the present study tested the hypothesis that enhancement of serotonergic neurotransmission through acute administration of the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Wong et al. 1995) in combination with a relatively selective 5-HT 1A receptor antagonist would alleviate the symptom of "dimin...

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Section: Discussionmentioning

confidence: 99%

Fluoxetine Combined with a Serotonin-1A Receptor Antagonist Reversed Reward Deficits Observed during Nicotine and Amphetamine Withdrawal in Rats

Harrison

Liem

Markou

2001

Neuropsychopharmacology

158

126

View full text Add to dashboard Cite

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“…Behavioral treatments may be needed to address these ancillary problems so that study subjects have a sufficient level of symptom control or stability to participate and/or hope to achieve benefit from the pharmacotherapy treatments being evaluated. For example, in studies of pharmacologic treatments for substance abusers with co-morbid psychiatric conditions (e.g., depressed cocaine abusers, schizophrenic cigarette smokers), the behavioral therapy platform should aim for an adequate and consistent level symptom control for the psychiatric disorder to enable the patient to participate in the trial (George et al, 2000;McDowell et al, 2000;Nunes et al, 1998;Schmitz et al, 2001a).…”

Section: Managing Problems Other Than Drug Usementioning

confidence: 99%

“…Relative strengths of CBT as a behavioral platform includes its established efficacy (DeRubeis and Crits-Christoph, 1998; Irvin et al, 1999;Miller and Wilbourne, 2002c;Morgenstern and Longabaugh, 2000), its durability beyond the active treatment period (Carroll et al, 2000;Carroll et al, 1994b;Rawson et al, 2002) as well as emerging evidence that it may have a complementary role with some pharmacotherapies (Anton et al, 1999;Carroll et al, 2004;Carroll et al, 1998a;Hall et al, 2002;Heinala et al, 2001;O'Malley et al, 1996;O'Malley et al, 2003). CBT's efficacy across a range of different psychiatric disorders (DeRubeis and Crits-Christoph, 1998) also makes this approach attractive for trials targeting populations with dual disorders (Brown et al, 1997;George et al, 2000;Mason et al, 1999;McDowell et al, 2000;Nunes et al, 1998;Patten et al, 1998;Schmitz et al, 2001a). Relative weaknesses of CBT are that comparatively extensive staff training is needed to learn to implement CBT effectively (Morgenstern et al, 2001;Sholomskas et al, 2002).…”

Section: Cognitive-behavioral Approachesmentioning

confidence: 99%

Choosing a behavioral therapy platform for pharmacotherapy of substance users

Carroll

Kosten

Rounsaville

2004

Drug and Alcohol Dependence

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Behavioral therapy platforms have become virtual requirements in pharmacotherapy trials due to their utility in reducing noise variability, preventing differential medication adherence and protocol attrition, enhancing statistical power and addressing ethical issues in placebo-controlled trials. Selecting an appropriate behavioral platform for a particular trial requires study-specific tailoring, taking into account both the stage of development of the medication being evaluated, as well as the specific strengths and weaknesses of a broad array of available empirically supported behavioral therapies and the range of their possible targets (e.g., enhancing medication adherence, preventing attrition, addressing co-morbid problems, fostering abstinence, and targeting specific weaknesses of the pharmacologic agent). Choosing a suitable behavioral platform also requires consideration of the characteristics of the population to be treated, stage of scientific knowledge regarding the medication's effects, appropriate balance of internal and external validity, and consideration of potential ceiling effects. Available manualized behavioral treatments are reviewed, noting their strengths and limitations as behavioral therapy platforms for pharmacotherapy trials and as potential concomitant therapies in clinical practice.

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“…For example, rehospitalization in schizophrenic patients is frequently precipitated by an episode of substance abuse combined with discontinuation of antipsychotic medications (100). For example, Nunes and colleagues' study (101) of the efficacy of the tricyclic antidepressant imipramine for reducing depression and illicit drug use among depressed methadone maintained patients reported a 38.7% rate of completion of an "adequate trial" of 6 weeks of imipramine, as measured by self-report and directly observed ingestion (direct observation was for approximately half of the doses). This rate of adherence is similar to other rates of adherence in other pharmacologic studies of depressed cocaine or opioid dependent patients (102).…”

Section: Medications For Comorbid Psychopathologymentioning

confidence: 99%

A Perfect Platform: Combining Contingency Management with Medications for Drug Abuse

Carroll

Rounsaville

2007

The American Journal of Drug and Alcohol Abuse

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Contingency management (CM) procedures, which provide concrete reinforcers or rewards contingent on verification of discrete targeted behaviors, such as drug-free urines, have been demonstrated to be effective in a number of clinical trials. However, to date there have been only a few that have capitalized on the unique strengths and capabilities of CM as an ideal platform to improve response to or address weaknesses of many pharmacotherapies used in the treatment of drug abuse. In this review, we describe the multiple potential uses of CM as a platform for pharmacotherapy, including reducing illicit drug use in the context of agonist therapies; fostering medication compliance with antagonists, aversive agents and HIV medications; fostering a period of abstinence prior to initiation of agents used to treat comorbid psychiatric conditions or in the context of vaccines to foster adequate periods of abstinence while titer levels are building; and to enhance the effectiveness of anticraving agents through additive or synergistic effects. Although its multiple strengths render it an almost perfect platform, CM does have some weaknesses that have limited its use to date, including cost, the short-term nature of its effects, and need for training. Future treatment development of CM as a medication platform needs to counter these issues by focusing on CM applications with large potential benefit, developing simple or automated methods for CM delivery and placing greater emphasis on the process of transitioning away from formal CM treatment. KeywordsContingency management; medication compliance; medication trials; study design There has been enormous progress in recent years in the identification of empirically-supported behavioral (1) and pharmacological (2,3) treatments for a range of drug use disorders. However, despite growing consensus that combined treatments are often the more effective than monotherapies (4,5), the bulk of the literature is based on trials in which a single treatment is systematically varied, and simultaneous testing of combined treatments is comparatively rare (6). There remains much room for improvement, however, as even for our most effective therapies response is often only partial or transient for many patients, while others fail to respond at all. Furthermore, the potential effectiveness of many behavioral and pharmacologic

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Imipramine Treatment of Opiate-Dependent Patients With Depressive Disorders

Cited by 152 publications

References 58 publications

Fluoxetine Combined with a Serotonin-1A Receptor Antagonist Reversed Reward Deficits Observed during Nicotine and Amphetamine Withdrawal in Rats

Fluoxetine Combined with a Serotonin-1A Receptor Antagonist Reversed Reward Deficits Observed during Nicotine and Amphetamine Withdrawal in Rats

Choosing a behavioral therapy platform for pharmacotherapy of substance users

A Perfect Platform: Combining Contingency Management with Medications for Drug Abuse

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