Pani Pier Paolo, Trogu Emanuela, Vecchi Simona, Amato Laura
Social-Health Division, Health District 8 (ASL 8) Cagliari, Via Logudoro 17, Cagliari, Sardinia, Italy, 09127.
Cochrane Database Syst Rev. 2011 Dec 7;2011(12):CD002950. doi: 10.1002/14651858.CD002950.pub3.
Cocaine dependence is a disorder for which no pharmacological treatment of proven efficacy exists, advances in the neurobiology could guide future medication development.
To investigate the efficacy and acceptability of antidepressants alone or in combination with any psychosocial intervention for the treatment of cocaine dependence and problematic cocaine use.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE and CINAHL in July 2011 and researchers for unpublished trials.
Randomised clinical trials comparing antidepressants alone or associated with psychosocial intervention with placebo, no treatment, other pharmacological or psychosocial interventions.
Two authors independently assessed trial quality and extracted data.
37 studies were included in the review (3551 participants).Antidepressants versus placebo: results for dropouts did not show evidence of difference, 31 studies, 2819 participants, RR 1.03 (Cl 95% 0.93 to 1.14). Looking at Abstinence from cocaine use, even though not statistically significant, the difference shown by the analysis in the three-weeks abstinence rate was in favour of antidepressants (eight studies, 942 participants, RR 1.22 (Cl 95% 0.99 to 1.51)). Considering only studies involving tricyclics, five studies, 367 participants, or only desipramine, four studies, 254 participants, the evidence was in favour of antidepressants. However, selecting only studies with operationally defined diagnostic criteria, statistical significance favouring antidepressants, as well as the trend for significance shown by the full sample, disappeared. Looking at safety issues, the results did not show evidence of differences (number of patients withdrawn for medical reasons, thirteen studies, 1396 participants, RR 1.39 (Cl 95% 0.91 to 2.12)). Subgroup analysis considering length of the trial, associated opioid dependence or associated psychosocial interventions as confounding factors, failed in showing consistent and statistically significant differences in favour of antidepressants.Antidepressants versus other drugs: Comparing antidepressants with dopamine agonists or with anticonvulsants, no evidence of differences was shown on dropouts and on other outcomes (abstinence from cocaine use, adverse events).
AUTHORS' CONCLUSIONS: At the current stage of evidence data do not support the efficacy of antidepressants in the treatment of cocaine abuse/dependence. Partially positive results obtained on secondary outcome measures, such as depression severity, do not seem to be associated with an effect on direct indicators of cocaine abuse/dependence. Antidepressants cannot be considered a mainstay of treatment for unselected cocaine abusers/dependents.
可卡因依赖是一种尚无经证实有效的药物治疗方法的疾病，神经生物学的进展可为未来药物研发提供指导。
研究单独使用抗抑郁药或联合任何心理社会干预措施治疗可卡因依赖及问题性可卡因使用的疗效和可接受性。
我们于2011年7月检索了Cochrane对照试验中心注册库（CENTRAL）、PubMed、EMBASE和CINAHL，并联系研究人员获取未发表的试验。
比较单独使用抗抑郁药或联合心理社会干预与安慰剂、不治疗、其他药物或心理社会干预的随机临床试验。
两位作者独立评估试验质量并提取数据。
本综述纳入了37项研究（3551名参与者）。抗抑郁药与安慰剂比较：脱落率结果未显示出差异，31项研究，2819名参与者，RR 1.03（95%CI 0.93至1.14）。从可卡因使用戒断情况来看，尽管无统计学显著性差异，但分析显示的三周戒断率差异有利于抗抑郁药（8项研究，942名参与者，RR 1.22（95%CI 0.99至1.51））。仅考虑涉及三环类药物的研究，5项研究，367名参与者，或仅考虑去甲丙咪嗪的研究，4项研究，254名参与者，证据有利于抗抑郁药。然而，仅选择具有操作性定义诊断标准的研究时，有利于抗抑郁药的统计学显著性以及全样本显示的显著性趋势消失了。从安全性问题来看，结果未显示出差异（因医学原因退出的患者数量，13项研究，1396名参与者，RR 1.39（95%CI 0.91至2.12））。将试验时长、相关阿片类药物依赖或相关心理社会干预作为混杂因素的亚组分析，未能显示出有利于抗抑郁药且一致且具有统计学显著性的差异。抗抑郁药与其他药物比较：将抗抑郁药与多巴胺激动剂或抗惊厥药比较，在脱落率和其他结局（可卡因使用戒断、不良事件）方面未显示出差异。
在当前证据阶段，数据不支持抗抑郁药治疗可卡因滥用/依赖的疗效。在次要结局指标（如抑郁严重程度）上获得的部分阳性结果，似乎与对可卡因滥用/依赖的直接指标无影响相关。抗抑郁药不能被视为未选择的可卡因滥用者/依赖者的主要治疗方法。
