Integrated Treatment for Cocaine and Mood Disorders - 1

The global aim of this study is to evaluate an "integrated" treatment approach for cocaine dependent patients with comorbid unipolar depression. It is hypothesized that a cognitive-behavioral psychotherapy that targets both disorders, in combination with a pharmacotherapy, i.e., bupropion, is expected to provide the best coverage for dual disorders and thus maximize treatment outcomes. Specifically, we will conduct a double blind, placebo-controlled clinical trial involving the random assignment of participants into one of four treatment conditions according to a full 2x2 factorial research design. One independent variable will be pharmacotherapy (bupropion versus placebo); the other independent variable will be psychotherapy (integrated CBT versus clinical management). The study will enroll 140 cocaine dependent patients with comorbid major depressive disorder. A secondary objective is to further elucidate "primary" and "secondary" paradigms of depressive illness symptoms in cocaine-dependent adults and better understand how this distinction influences treatment outcome. This will be accomplished by enrolling a subsample of patients with substance-induced mood disorder. Taken together, this proposal will examine the feasibility and relative efficacy of a novel integrated treatment model for dually-diagnosed patients.

Inclusion criteria

• Generally physically healthy
• Aged 18-55
• Meets cocaine dependence by DSM-IV criteria
• Meets major depressive disorder or substance-induced depression disorder by DSM-IV criteria.
• Willing and able to participate in the 12 week treatment study and one year follow up.

Exclusion criteria

• Pregnant or breastfeeding.
• Taking medications that interact with the study medication (MAO inhibitors, anticonvulsants, haloperidol, phenothiazines,selegiline, anesthetics
• Have other psychiatric diagnoses requiring therapy or medication.
• Physically dependent on opiates or alcohol.
• Currently being treated with bupropion hydrochloride (e.g. Zyban).