Venlafaxine Treatment is Associated with Improved Mood, but Not Decreased Cocaine Self-administration, in Depressed People Who Use Cocaine

Individuals seeking treatment for their cocaine use often report depressive systems and nearly half meet criteria for major depressive disorder (MDD). This descriptive study aimed to assess the effects of the antidepressant venlafaxine alone and in combination with gabapentin on depressive symptoms, subjective effects of cocaine, and cocaine self-administration in depressed and non-depressed people who use cocaine. The effects of medication condition on mood and on the effects of smoked cocaine were compared between a group of clinically depressed people who use cocaine (n = 5) and a control group of non-depressed people who use cocaine (n = 5) using laboratory-based measures. In the MDD group, venlafaxine (300 mg/day) was associated with reduced mean Beck Depression Inventory (BDI) scores (35 to <5) and marginally lower ratings of "good drug effect" without affecting cocaine "wanting" or cocaine (0-50 mg) self-administration. In both groups, venlafaxine treatment increased resting heart rate, systolic pressure, and diastolic pressure. The addition of gabapentin (2400 mg/day) had no effect relative to venlafaxine alone for either group. Conclusions regarding venlafaxine's effectiveness in treating depression in the MDD group are tempered by the lack of a venlafaxine placebo condition and by reductions in BDI scores associated with abstinence prior to venlafaxine administration. Further research is necessary to identify effective treatments for depressed people who use cocaine.