Antidepressants May Help People Stop Use of Cocaine While in Treatment for Opioid Use Disorder

Did you know that for some people who are undergoing methadone treatment for opioid addiction, using cocaine can also be a challenge? However, there’s some promising news from researchers at Johns Hopkins Medicine. They’ve found that bupropion (brand name Wellbutrin xl 300 mg), a medication typically used as an antidepressant and to help people quit smoking, might also help individuals stop using cocaine. At the same time, they’re being treated for opioid use disorder (OUD). This exciting development was detailed in a recent study published on March 15 in JAMA Network Open.

How Was the Double-Blind Randomized Study Conducted?

The researchers adopted what’s known as an adaptive treatment design for this study. This approach is pretty cool because it allows for changes to be made to the trial and its analysis methods as it progresses, making it highly flexible. From March 2015 to September 2019, they brought together 80 adults who were already receiving methadone treatment for opioid use disorder. All participants had used cocaine at least once within the 30 days before joining the study. Most of them were around 48 years old, and the majority, about 66%, were men.

The participants were split into two groups. Half of them were given bupropion—up to 300 mg twice a day, taken orally. The other half received a placebo, which is essentially a treatment that looks like the medicine but doesn’t contain the active substance. Both groups were closely monitored, meeting with researchers three times a week for a period of 30 weeks. 

How Were Incentives Used in the Study?

In the study, a clever twist was added: the use of monetary incentives. At each visit, participants gave urine samples and reported on their cocaine use. Those who provided cocaine-negative urine samples during the first 26 weeks were rewarded with money. The incentives started small, just 50 cents per negative sample, but increased significantly as the study progressed. If the sample was positive for cocaine, however, no reward was given.

Kelly Dunn, Ph.D., MBA, a professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, explains the rationale behind this approach. “Many of our patients on methadone treatment express a desire to stop using cocaine, but finding effective treatments has been challenging,” says Dr. Dunn. “Monetary incentives have proven to be one of the most effective methods for treating cocaine use disorder.”

Here’s another interesting aspect: the incentives were not one-size-fits-all. Based on how participants responded in the first six weeks, the incentives were tailored. Those who stopped using cocaine early on received incentives aimed at preventing relapse. Those who continued to use were offered enhanced incentives to encourage them to stop.

After this initial six-week phase, participants continued in the study, receiving either the medication or a placebo. The effectiveness of combining medication with incentives was then evaluated by comparing the outcomes of those on medication versus those on placebo and, within these groups, comparing those who received standard versus enhanced incentives. This innovative approach allowed researchers to see which combination was most effective in helping participants reduce or stop their cocaine use.

What Were the Key Findings from the Study?

The medication bupropion itself didn’t show a significant effect compared to the placebo when looking at all participants together. However, when we dive deeper into the details, something intriguing emerges among those who received monetary incentives to help quit cocaine.

For participants who were given these incentives and also took bupropion, 67% were not using cocaine by the end of the study. That’s a pretty impressive number! In contrast, only 30% of those who received the same incentives but took a placebo-managed to stay cocaine-free. This suggests that bupropion might be particularly effective when paired with financial incentives for those trying to kick their cocaine habit. On the flip side, for participants who received incentives aimed at preventing relapse (those who had already stopped using cocaine), adding bupropion didn’t provide any extra benefit over the placebo.

What Were the Implications?

Dr. Dunn sees real potential in these findings. She suggests that combining bupropion with monetary incentives even after the end of the incentive could be a very effective approach. “Our research indicates that bupropion is beneficial for a specific group of people with opioid use disorder. How they initially respond to the treatment really helps us determine how intense their future treatment needs to be,” she explains.

But this isn’t the end of the road. The team behind the study emphasizes the need for further research. They’re particularly interested in understanding the long-term effects for these patients. How long do they stay off cocaine? What’s the risk of relapsing? These are critical questions that need answers. Additionally, Dr. Dunn points out another crucial area of focus: finding the ideal duration for medication treatment. “We’re looking to determine how long people should be on bupropion to extend the benefits of abstinence even further,” she says.

What Are the Other Positive Effects of Antidepressants?

Antidepressants, when used as part of a comprehensive treatment plan that includes therapy and holistic wellness activities, can significantly improve the quality of life for those dealing with mental health disorders. Think of it as a three-part strategy for wellness, with antidepressants being a key component in managing some of the tougher symptoms that can interfere with everyday life.

It’s important to note that antidepressants don’t work overnight. It might take a few weeks to really notice a difference. But in the meantime, therapy sessions and engaging in holistic activities like yoga or meditation can provide some immediate comfort and relief. Once the antidepressants start kicking in, they help to stabilize the distressing symptoms. For many, this can mean a major reduction in their symptoms, and some might even see their symptoms go away entirely.

These Mental Health Disorders May Benefit from the Positive Effects of Antidepressants

Antidepressants are not just for depression—they can be a key part of treatment for a variety of mental health conditions. Sometimes, they’re even combined with other types of medications like antipsychotics, anti-anxiety meds, or mood stabilizers to create a tailored treatment plan. Let’s take a closer look at some of the conditions that may benefit from antidepressants:

• Depression: This is probably what most people think of when they hear “antidepressants.” It affects over 17 million Americans each year and comes in several forms, such as seasonal affective disorder, dysthymia, postpartum depression, and bipolar depression. Symptoms often include persistent sadness, fatigue, changes in eating or sleeping patterns, loss of interest in activities, and even thoughts of suicide.
• Anxiety Disorders: These are the most common mental health issues in the US, affecting around 40 million adults. Types of anxiety disorders include generalized anxiety disorder, social anxiety, various phobias, and panic disorder. Symptoms can range from irrational worry and fear to physical signs like heart palpitations, sweating, and dizziness.
• Bipolar Disorder: Known for its dramatic mood swings, bipolar disorder can oscillate between episodes of mania and depression. It manifests in behaviors like impulsivity, high-risk activities, and intense irritability. There are several subtypes, including bipolar I, bipolar II, cyclothymic, and unspecified.
• Personality Disorders: These disorders involve enduring patterns of behavior and inner experiences that deviate from the norm and can result in troubled relationships and self-image. Common types include antisocial, borderline, and narcissistic personality disorders. Not all personality disorders respond well to antidepressants, but some do find relief with them.
• Binge Eating Disorder: This is an eating disorder where individuals feel unable to stop eating and frequently consume large quantities of food. It’s often linked with feelings of numbness during binges, stockpiling food, and persistent dissatisfaction after eating. Antidepressants can be particularly useful here, possibly because of the frequent overlap with depressive symptoms.

Each of these conditions is complex and unique. While antidepressants are crucial in treatment, they are most effective when part of a broader, personalized plan that may include therapy and other interventions. You can also buy your antidepressants from the best Canadian online pharmacy to maintain their safety and efficacy.

Conclusion

More research is needed to figure out how long people should use bupropion to keep them from going back to using drugs and to look at the long-term effects, including how often people might start using again. Antidepressants are becoming a beacon of hope for many, especially in managing mental health issues alongside other disorders like opioid and cocaine addiction. They are crucial in treatment plans and have shown promising results when used with other therapies.

These medications are key to helping people recover from substance abuse or alleviate various mental health conditions. Patients need to work closely with their doctors to customize their treatment for the best results. As we learn more about what antidepressants can do, their value in enhancing overall well-being and improving life quality is clear and invaluable.