Philadelphia, PA, November 28, 2012 Medication development efforts for cocaine dependence have yet to result in an FDA approved treatment. The powerful rewarding effects of cocaine, the profound disruptive impact of cocaine dependence on one's lifestyle, and the tendency of cocaine to attract people who make poor life choices and then exacerbate impulsive behavior all make cocaine a vexing clinical condition.
In this battle, many candidate pharmacotherapies have been tested, but none have succeeded sufficiently to be adopted widely. Perhaps like cancer, heart disease, and AIDS, cocaine dependence is a disorder that requires combinations of medications for effective treatment.
In this issue of Biological Psychiatry, researchers from Columbia University and New York State Psychiatric Institute report a step forward in this effort. They tested a medication approach that unites two themes in addiction research amphetamine and topiramate.
There are clues that stimulants, like amphetamine, methylphenidate, and modafinil, reduce reward dysfunction and deficits in executive cognitive control mechanisms associated with addiction. This approach fits with the "self-medication" hypothesis of addiction, which suggests that some people use drugs to treat symptoms that lead them to addiction or that emerge as a consequence of addiction.
There is also evidence that topiramate may be the most effective current pharmacotherapy for alcoholism. There are gaps in our understanding of exactly how topiramate works to combat addiction, but it shows signs of efficacy in animal models of stimulant addiction. In a recent large study of methamphetamine addiction, it appeared to reduce the intensity of methamphetamine use.
Using this knowledge as building blocks, Mariani and colleagues set out to test a combination of mixed amphetamine salts and topiramate for the treatment of cocaine dependence. They recruited cocaine-dependent treatm
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