Drug and AlcoholDependence 63 (2001) 207 – 214 Fluoxetine treatment of cocaine-dependent patients with major depressive disorder Joy M. Schmitz *,Patricia Averill,Angela L. Stotts, F. Gerard Moeller, Howard M. Rhoades, John Grabowski Department of Psychiatry and Beha6ioral Sciences, Substance Abuse Research Center, Uni6ersity of Texas Medical School Houston, Houston, TX 77030 , USA Received 3 May 2000; received in revised form 31 August 2000; accepted 21 September 2000 Abstract Sixty-eight male and female individuals with both DSM-IV diagnoses of cocaine dependence and major depressive disorder wererandomly assigned to oneof two medication conditions (placebo vs.40 mg per day) as part of a double-blind, placebo-controlled clinical efficacy trial of fluoxetine for the treatment of this dualdiagnosis. During the 12-week outpatient treatmentphase allparticipantsalso received individual cognitive-behavioral psychotherapy targeting both cocaine use and depression. Depressive symptoms remitted as a function of time in treatment, with no significant medication effects found. Fe cocaine positive urines were found during the first 6 weeks of treatment in the placebo group compared with the 40-mg group Cocaine use and depressive symptoms during treatment were significantly correlated. The findings failto supportthe role of fluoxetine for treatment of cocaine use and depression in dually-diagnosed patients. © 2001 Elsevier Science Ireland Ltd. All r reserved. Keywords : Fluoxetine;Cocaine;Depression; Dual-diagnosis; Treatment www.elsevier.com/locate/drugalcdep 1.Introduction The use of antidepressant medications in treating cocaine dependence has received mixed support. The pharmacologic rationale for examining antidepressants is based, in part, on the clinical observation of frequent depressivesymptomsamong cocaineabusersseeking treatment. To the extentthat certain antidepressants exert their effects by ameliorating hypothesized cocaine- induced neurotransmitter deficiency,especiallydo- pamine(Gorelick, 1998),this treatmentapproach is rational.The tricyclic antidepressant desipramine was the first medication found effective in an outpatient, double-blind,controlled clinicaltrial (Gawin et al., 1989);however, these positive findings were not repli- cated in many ofthe larger controlled trials that fol- lowed (Arndt et al., 1992; Campbell et al., 1994; Carroll et al., 1995).Open-labelstudiesof otherheterocyclic antidepressants, including imipramine and maprotiline, have suggested some effect in reducing cocaine use over periods of several weeks (Brotman et al., 1988).Of the antidepressant medications that specifically inhibit the uptake ofserotonin,fluoxetine has been studied most extensively. Whereas two early pilot studies offluox- etine were promising (Pollack and Rosenbaum, 1991; Batki et al., 1993), later double-blind, controlled clinical trials found no significant advantage of fluoxetine over placebo in reducing cocaine use or craving (Covi et al., 1995;Grabowskiet al.,1995;Batkiet al.,1996). Treatment studies evaluating antidepressant pharma- cotherapy for comorbid cocaine dependence and unipo- lar depression have had inconsistent results. Carroll et al. (1995)evaluated treatment response for depressed versus nondepressed cocaine abusers in a 12-week con- trolled trial of desipramineand cognitive-behavioral treatment, alone and in combination. The results indi- cated specificityof effects,with desipramine(vs. placebo) associated with significantly greater reduction * Corresponding author. Presentaddress:DepartmentofPsychi- atry and BehavioralSciences,SubstanceAbuse Research Center, U.T. Mental SciencesInstitue,Moursund Avenue,Houston, TX 77030, USA. Tel.: + 1-713-5002867; fax: + 1-713-5002849. E-mail address : joy.m.schmitz@uth.tmc.edu (J.M. Schmitz). 0376-8716/01/$ - see front matter © 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S0376-8716(00)00208-8