Cornelius J R, Salloum I M, Thase M E, Haskett R F, Daley D C, Jones-Barlock A, Upsher C, Perel J M
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15213, USA.
Psychopharmacol Bull. 1998;34(1):117-21.
To date, few double-blind, placebo-controlled studies with any selective serotonin reuptake inhibitor (SSRI) antidepressant in pure cocaine abusers or in cocaine abusers with comorbid disorders have been reported. In this study, 17 patients with DSM-III-R diagnoses of major depressive disorder, alcohol dependence, and cocaine abuse were included along with 34 non-cocaine-abusing depressed alcoholics in a pharmacotherapy trial involving the SSRI antidepressant fluoxetine. All 51 patients participated in a double-blind, parallel group study of fluoxetine versus placebo in depressed alcoholics. The principal focus of this article is the one-third of the depressed alcoholics who also abused cocaine and how the treatment response of those 17 patients compared with that of the 34 depressed alcoholics who did not abuse cocaine. During the study, no significant difference in treatment outcome was noted between the fluoxetine group (N = 8) and the placebo group (N = 9) for cocaine use, alcohol use, or depressive symptoms. In addition, no significant within-group improvement was noted for any of these outcome variables in either of the two treatment groups. Indeed, across the combined sample of 17 depressed alcoholic cocaine abusers, the mean Beck Depression Inventory (BDI) score worsened slightly from 19 to 21 during the course of the study, and 71 percent of the patients continued to complain of suicidal ideations at the end of the study. The 17 cocaine-abusing depressed alcoholics showed a significantly worse outcome than the 34 non-cocaine abusing depressed alcoholics on the 24-item Hamilton Rating Scale for Depression (HAM-D) and BDI depression scales and on multiple measures of alcohol consumption. These findings suggest that comorbid cocaine abuse acts as a robust predictor of poor outcome for the drinking and the depressive symptoms of depressed alcoholics.
迄今为止，几乎没有关于在单纯可卡因滥用者或伴有共病的可卡因滥用者中使用任何选择性5-羟色胺再摄取抑制剂（SSRI）抗抑郁药的双盲、安慰剂对照研究报告。在本研究中，17名被诊断患有重度抑郁症、酒精依赖和可卡因滥用的DSM-III-R患者，与34名不滥用可卡因的抑郁酗酒者一起纳入了一项涉及SSRI抗抑郁药氟西汀的药物治疗试验。所有51名患者参与了一项关于氟西汀与安慰剂治疗抑郁酗酒者的双盲、平行组研究。本文的主要关注点是三分之一同时滥用可卡因的抑郁酗酒者，以及这17名患者的治疗反应与34名不滥用可卡因的抑郁酗酒者的治疗反应相比情况如何。在研究期间，氟西汀组（N = 8）和安慰剂组（N = 9）在可卡因使用、酒精使用或抑郁症状方面，治疗结果没有显著差异。此外，两个治疗组中任何一个组内这些结果变量均未出现显著改善。实际上，在17名抑郁酗酒可卡因滥用者的合并样本中，研究过程中贝克抑郁量表（BDI）平均分从19略微恶化至21，并且71%的患者在研究结束时仍抱怨有自杀念头。在24项汉密尔顿抑郁评定量表（HAM-D）、BDI抑郁量表以及多项酒精消费测量指标上，17名滥用可卡因的抑郁酗酒者的结果明显比34名不滥用可卡因的抑郁酗酒者更差。这些发现表明，共病的可卡因滥用是抑郁酗酒者饮酒和抑郁症状预后不良的有力预测指标。
