Titre : | Comorbid major depressive disorder as a prognostic factor in cocaine-abusing buprenorphine-maintained patients treated with desipramine and contingency management |
Titre traduit : | (Troubles dépressifs majeurs et comorbides comme facteur de prognostic pour les usagers de cocaïne en traitement de maintenance à la buprénorphine, et traités avec la désipramine et la gestion des contingences) |
Auteurs : | G. GONZALEZ ; FEINGOLD A. ; A. OLIVETO ; GONSAI K. ; T. R. KOSTEN |
Type de document : | Périodique |
Année de publication : | 2003 |
Format : | 497-514 / fig. ; tabl. |
Note générale : |
American Journal of Drug and Alcohol Abuse (The), 2003, 29, (3), 497-514 |
Langues: | Anglais |
Discipline : | TRA (Traitement et prise en charge / Treatment and care) |
Mots-clés : |
Thésaurus mots-clés DEPRESSION ; TRAITEMENT ; BUPRENORPHINE ; ANTIDEPRESSEURS ; ACCOMPAGNEMENT ; COMORBIDITE |
Résumé : |
ENGLISH : Depression is common among patients who abuse both opiates and cocaine, and its treatment has had mixed success. This study compares buprenorphine-maintained patients with lifetime major depressive disorder (MDD, N = 53) with those never depressed (ND, N = 96) on cocaine and opiate-free urines during a 12-week outpatient double-blind, placebo-controlled, randomized clinical trial. The 149 subjects were assigned to four groups: 1) desipramine (DMI) + contingency management (CM) ; 2) DMI + noncontingency management (NCM) ; 3) placebo + CM ; and 4) placebo + NCM. Depression assessments included Hamilton Depression Rating Scale, Center for Epidemiological Studies Depression Inventory, and Structured Clinical Interview for DSM-IV interview for diagnosis of lifetime MDD. Urine toxicologies were performed thrice weekly and the CES-D was performed monthly. The MDD group had a larger proportion of females (45% vs 21%, P= 0.02) and were more likely to be married (13.2% vs 7.3%, P = 0.02) than the ND group. Treatment retention did not vary by depression status. Hierarchical Linear Modeling found that depressive symptoms decreased comparably across the four treatment groups. Although participation in CM improved drug-free urines more for patients with MDD than for the ND group (Z = 2.44, P = 0.01), treatment with DMI was significantly more efficacious for the ND group than for the MDD group (Z= -2.89, P = 0.003). These results suggest that patients with MDD may respond better to behavioral treatments such as CM than to desipramine plus buprenorphine. The ND cocaine-abusing, opiate-dependent patients may be more responsive to the anticraving effects of DMI. (Author' s abstract) |
Note de contenu : | fig. ; tabl. |
Domaine : | Drogues illicites / Illicit drugs |
Refs biblio. : | 37 |
Affiliation : |
Dept Psychiatry, Yale Univ. School Med., VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516 Etats-Unis. United States. |
Numéro Toxibase : | 207291 |
Centre Emetteur : | 02 Coordonnateur |
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