Szerman N, Peris L, Mesías B, Colis P, Rosa J, Prieto A
Moratalaz Mental Health Department, Madrid, Spain.
Hum Psychopharmacol. 2005 Apr;20(3):189-92. doi: 10.1002/hup.677.
Although several approaches have been attempted for cocaine dependence, the pharmacological treatment of this serious disorder remains unclear. To date, desipramine, a tricyclic antidepressant of great noradrenergic activity, has shown the best results. Reboxetine, a selective noradrenaline reuptake inhibitor, might be an effective therapeutic option for this severe drug addiction. The aim was preliminarily to assess reboxetine in a group of cocaine dependent patients, selected from The Madrid City Council Drug Addiction Program primary care centres.
Twenty six patients with a diagnosis of cocaine dependence disorder (DSM-IV 304.20) were selected to receive open treatment with reboxetine, 8 mg/day, for 12 weeks. Follow up assessments comprised cocaine consumption, treatment retention rate and change in standard structured psychometric instrument scores: cocaine selective severity assessment, Hamilton anxiety scale, Hamilton depression scale and clinical global impression, throughout the treatment period.
Data were obtained from 20 patients; 10 of them remained abstinent, whereas the other 10 consumed cocaine at some time during the study. The treatment retention rate at week 12 was 61.5%. The psychometric instrument mean scores showed marked decreases throughout the treatment period.
Reboxetine might be an effective and safe therapeutic option for cocaine dependence disorder. The aversive effects, as well as the high blockage reported by some patients consuming cocaine during the trial, might be related to treatment. If confirmed in large clinical trials, the trends suggested by this study would confirm the role of noradrenergic function in the treatment of cocaine dependence.
尽管针对可卡因依赖尝试了多种方法，但这种严重疾病的药物治疗仍不明确。迄今为止，去甲丙咪嗪，一种具有强大去甲肾上腺素能活性的三环类抗抑郁药，已显示出最佳效果。瑞波西汀，一种选择性去甲肾上腺素再摄取抑制剂，可能是治疗这种严重药物成瘾的有效选择。目的是初步评估瑞波西汀在一组从马德里市议会药物成瘾项目初级保健中心选取的可卡因依赖患者中的疗效。
选取26名诊断为可卡因依赖障碍（DSM-IV 304.20）的患者，接受瑞波西汀8毫克/天的开放治疗，为期12周。随访评估包括整个治疗期间的可卡因消耗量、治疗保留率以及标准结构化心理测量工具评分的变化：可卡因选择性严重程度评估、汉密尔顿焦虑量表、汉密尔顿抑郁量表和临床总体印象。
获得了20名患者的数据；其中10人保持戒断状态，而另外10人在研究期间的某个时间使用了可卡因。第12周的治疗保留率为61.5%。心理测量工具的平均评分在整个治疗期间显著下降。
瑞波西汀可能是治疗可卡因依赖障碍的一种有效且安全的选择。厌恶效应以及一些患者在试验期间使用可卡因时报告的高度阻断感可能与治疗有关。如果在大型临床试验中得到证实，本研究表明的趋势将证实去甲肾上腺素能功能在治疗可卡因依赖中的作用。
