28 de setembro de 2020

Lamotrigine Reduces Craving and Depressive Symptoms in Cocaine Dependence

3 de março de 20119min

J Neuropsychiatry Clin Neurosci 23:32E, Winter 2011 
doi: 10.1176/appi.neuropsych.23.1.E32
© 2011 American Neuropsychiatric Association

Lamotrigine Reduces Craving and Depressive Symptoms in Cocaine Dependence

Zoran Pavlovic, M.D.

Private Practice, Belgrade, Serbia 
To the Editor: The importance of glutamatergic projections can be seen superficially in neuroimaging studies where blood flow to the anterior cingulate cortex, ventral orbital cortex, and amygdala is increased during craving for a variety of addictive drugs.1,2 Cocaine craving was found to be significantly associated with time-to-relapse.3 Furthermore, several lines of evidence suggest a link between cocaine-primed craving and depressive symptomatology.4Lamotrigine reduces acute depressive symptoms (epilepsy, treatment-resistant depression)5,6and has been shown to be effective in reducing cocaine craving in bipolar disorder comorbid with cocaine dependence7 and alcohol use disorders.8 Lamotrigine affects glutamate by inhibiting high-voltage-activated calcium channels that are located presynaptically, and consequently inhibits its release.2,9

I present three patients diagnosed with cocaine dependence according to the DSM-IV criteria. They had used cocaine for an average of 5.4 years, and they had made an average of 3.1 quit attempts in their lifetimes. Patients had used cocaine for an average of 12.10 days during the 30 days before completing the baseline assessment battery. Their average baseline Cocaine Craving Questionnaire—Brief10 score was 48 and corresponding Beck Depression Inventory (BDI) score was 17. After 12 weeks on lamotrigine monotherapy, 200 mg/day, the respective scores decreased to 7 on the BDI and 21 on the Cocaine Craving Questionnaire, with no reports of relapse.

My results suggest that lamotrigine might have bimodal action by reducing craving and depression symptoms and thus could be a useful drug in preventing relapse in cocaine dependence.

REFERENCES

 

  1. Goldstein RA, Volkow ND: Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex. Am J Psychiatry 2002; 159:1642–1652[Abstract/Free Full Text]
  2. Uys JD, LaLumiere RT: Glutamate: the new frontier in pharmacotherapy for cocaine addiction. CNS Neurol Disord Drug Targets 2008; 7:482–491[CrossRef][Medline]
  3. Paliwal P, Scott M, Hymana MS, et al: Craving predicts time to cocaine relapse: Further validation of the Now and Brief versions of the cocaine craving questionnaire. Drug Alcohol Depend 2008; 93:252–259[CrossRef][Medline]
  4. Elman I, Karlsgodt KH, Gastfriend DR, et al: Cocaine-primed craving and its relationship to depressive symptomatology in individuals with cocaine dependence. J Psychopharmacol 2002; 16:163–167[Abstract/Free Full Text]
  5. Fakhoury TA, Miller JM, Hammer AE, et al: Effects of lamotrigine on mood in older adults with epilepsy and comorbid depressive symptoms: an open-label, multicenter, prospective study. Drugs Aging 2008; 25:955–962[CrossRef][Medline]
  6. Santos MA, Rocha FL, Hara C: Efficacy and safety of antidepressant augmentation with lamotrigine in patients with treatment-resistant depression: a randomized, placebo-controlled, double-blind study. Prim Care Companion J Clin Psychiatry 2008; 10:187–190[CrossRef][Medline]
  7. Brown SE, Perantie DC, Dhanani N, et al: Lamotrigine for bipolar disorder and comorbid cocaine dependence: a replication and extension study. J Affect Disord 2006; 93: 219–222[CrossRef][Medline]
  8. Pavlovic ZM: Case report: long-term treatment and relapse prevention of alcohol and benzodiazepine dependence with lamotrigine (letter). J Neuropsych Clin Neurosciences 2010 Spring; 22:E25–E6 (published online May 2010)
  9. Xie X, Hagan RM: Cellular and molecular actions of lamotrigine: possible mechanisms of efficacy in bipolar disorder. Neuropsychobiology 1998; 38:119–130[CrossRef][Medline]
  10. Sussner BD, Smelson DA, Rodrigues S, et al: The validity and reliability of a brief measure of cocaine craving. Drug Alcohol Depend 2006; 83, 233–237[CrossRef][Medline]

Sobre a UNIAD

A Unidade de Pesquisa em álcool e Drogas (UNIAD) foi fundada em 1994 pelo Prof. Dr. Ronaldo Laranjeira e John Dunn, recém-chegados da Inglaterra. A criação contou, na época, com o apoio do Departamento de Psiquiatria da UNIFESP. Inicialmente (1994-1996) funcionou dentro do Complexo Hospital São Paulo, com o objetivo de atender funcionários dependentes.



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