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Letters   |    
Lamotrigine Reduces Craving and Depressive Symptoms in Cocaine Dependence
Zoran Pavlovic, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2011;23:E32-E32.

To the Editor: The importance of glutamatergic projections can be seen superficially in neuroimaging studies where blood flow to the anterior cingulate cortex, ventral orbital cortex, and amygdala is increased during craving for a variety of addictive drugs.1,2 Cocaine craving was found to be significantly associated with time-to-relapse.3 Furthermore, several lines of evidence suggest a link between cocaine-primed craving and depressive symptomatology.4 Lamotrigine reduces acute depressive symptoms (epilepsy, treatment-resistant depression)5,6 and has been shown to be effective in reducing cocaine craving in bipolar disorder comorbid with cocaine dependence7 and alcohol use disorders.8 Lamotrigine affects glutamate by inhibiting high-voltage-activated calcium channels that are located presynaptically, and consequently inhibits its release.2,9

I present three patients diagnosed with cocaine dependence according to the DSM-IV criteria. They had used cocaine for an average of 5.4 years, and they had made an average of 3.1 quit attempts in their lifetimes. Patients had used cocaine for an average of 12.10 days during the 30 days before completing the baseline assessment battery. Their average baseline Cocaine Craving Questionnaire—Brief10 score was 48 and corresponding Beck Depression Inventory (BDI) score was 17. After 12 weeks on lamotrigine monotherapy, 200 mg/day, the respective scores decreased to 7 on the BDI and 21 on the Cocaine Craving Questionnaire, with no reports of relapse.

My results suggest that lamotrigine might have bimodal action by reducing craving and depression symptoms and thus could be a useful drug in preventing relapse in cocaine dependence.

Goldstein  RA;  Volkow  ND:  Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex.  Am J Psychiatry 2002; 159:1642–1652
[PubMed]
[CrossRef]
 
Uys  JD;  LaLumiere  RT:  Glutamate: the new frontier in pharmacotherapy for cocaine addiction.  CNS Neurol Disord Drug Targets 2008; 7:482–491
[PubMed]
[CrossRef]
 
Paliwal  P;  Scott  M;  Hymana  MS  et al:  Craving predicts time to cocaine relapse: Further validation of the Now and Brief versions of the cocaine craving questionnaire.  Drug Alcohol Depend 2008; 93:252–259
[PubMed]
[CrossRef]
 
Elman  I;  Karlsgodt  KH;  Gastfriend  DR  et al:  Cocaine-primed craving and its relationship to depressive symptomatology in individuals with cocaine dependence.  J Psychopharmacol 2002; 16:163–167
[PubMed]
[CrossRef]
 
Fakhoury  TA;  Miller  JM;  Hammer  AE  et al:  Effects of lamotrigine on mood in older adults with epilepsy and comorbid depressive symptoms: an open-label, multicenter, prospective study.  Drugs Aging 2008; 25:955–962
[PubMed]
[CrossRef]
 
Santos  MA;  Rocha  FL;  Hara  C:  Efficacy and safety of antidepressant augmentation with lamotrigine in patients with treatment-resistant depression: a randomized, placebo-controlled, double-blind study.  Prim Care Companion J Clin Psychiatry 2008; 10:187–190
[PubMed]
[CrossRef]
 
Brown  SE;  Perantie  DC;  Dhanani  N  et al:  Lamotrigine for bipolar disorder and comorbid cocaine dependence: a replication and extension study.  J Affect Disord 2006; 93: 219–222
[PubMed]
[CrossRef]
 
Pavlovic  ZM:  Case report: long-term treatment and relapse prevention of alcohol and benzodiazepine dependence with lamotrigine (letter).  J Neuropsych Clin Neurosciences 2010Spring; 22:E25–E6(published online May 2010)
 
Xie  X;  Hagan  RM:  Cellular and molecular actions of lamotrigine: possible mechanisms of efficacy in bipolar disorder.  Neuropsychobiology 1998; 38:119–130
[PubMed]
[CrossRef]
 
Sussner  BD;  Smelson  DA;  Rodrigues  S  et al:  The validity and reliability of a brief measure of cocaine craving.  Drug Alcohol Depend 2006; 83, 233–237
[PubMed]
[CrossRef]
 
References Container
+

References

Goldstein  RA;  Volkow  ND:  Drug addiction and its underlying neurobiological basis: neuroimaging evidence for the involvement of the frontal cortex.  Am J Psychiatry 2002; 159:1642–1652
[PubMed]
[CrossRef]
 
Uys  JD;  LaLumiere  RT:  Glutamate: the new frontier in pharmacotherapy for cocaine addiction.  CNS Neurol Disord Drug Targets 2008; 7:482–491
[PubMed]
[CrossRef]
 
Paliwal  P;  Scott  M;  Hymana  MS  et al:  Craving predicts time to cocaine relapse: Further validation of the Now and Brief versions of the cocaine craving questionnaire.  Drug Alcohol Depend 2008; 93:252–259
[PubMed]
[CrossRef]
 
Elman  I;  Karlsgodt  KH;  Gastfriend  DR  et al:  Cocaine-primed craving and its relationship to depressive symptomatology in individuals with cocaine dependence.  J Psychopharmacol 2002; 16:163–167
[PubMed]
[CrossRef]
 
Fakhoury  TA;  Miller  JM;  Hammer  AE  et al:  Effects of lamotrigine on mood in older adults with epilepsy and comorbid depressive symptoms: an open-label, multicenter, prospective study.  Drugs Aging 2008; 25:955–962
[PubMed]
[CrossRef]
 
Santos  MA;  Rocha  FL;  Hara  C:  Efficacy and safety of antidepressant augmentation with lamotrigine in patients with treatment-resistant depression: a randomized, placebo-controlled, double-blind study.  Prim Care Companion J Clin Psychiatry 2008; 10:187–190
[PubMed]
[CrossRef]
 
Brown  SE;  Perantie  DC;  Dhanani  N  et al:  Lamotrigine for bipolar disorder and comorbid cocaine dependence: a replication and extension study.  J Affect Disord 2006; 93: 219–222
[PubMed]
[CrossRef]
 
Pavlovic  ZM:  Case report: long-term treatment and relapse prevention of alcohol and benzodiazepine dependence with lamotrigine (letter).  J Neuropsych Clin Neurosciences 2010Spring; 22:E25–E6(published online May 2010)
 
Xie  X;  Hagan  RM:  Cellular and molecular actions of lamotrigine: possible mechanisms of efficacy in bipolar disorder.  Neuropsychobiology 1998; 38:119–130
[PubMed]
[CrossRef]
 
Sussner  BD;  Smelson  DA;  Rodrigues  S  et al:  The validity and reliability of a brief measure of cocaine craving.  Drug Alcohol Depend 2006; 83, 233–237
[PubMed]
[CrossRef]
 
References Container
+
+

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