A pharmacological agent with proven efficacy does not exist for treatment of cocaine dependence. Cocaine is an alkaloid derived from the erythroxylon coca leaf that is used as powder for intranasal or intravenous use or as crack, a free-base form which is smoked. Cocaine dependence is a major public health problem because its use can be associated with medical and psychosocial complications including the spread of infectious diseases (such as AIDS, hepatitis and tuberculosis), crime, violence and neonatal drug exposure. This review looked at the evidence on the efficacy and acceptability of antidepressants alone or in combination with a psychosocial intervention for the treatment of cocaine abuse and dependence.

Current evidence from randomised controlled trials does not support the use of antidepressants. Positive results obtained by antidepressants on mood-related outcomes are consistent with the primary effect of antidepressants. They do not seem to be associated with any effect on dropouts from treatment, cocaine use or side effects, which are direct indicators of cocaine abuse and dependence. A total of 37 randomised controlled clinical studies involving 3551 participants were included in the review. All the studies except one took place in the USA; 33 trials were conducted with outpatients in the community or in mental health centres. In 10 trials patients were also treated for opioid dependence with methadone or buprenorphine. The antidepressants included desipramine, fluoxetine and bupropion and the mean duration of the trials was 10.7 weeks. The included studies utilised 43 different rating instruments and differed in design, quality, characteristics of patients, tested medication, services and the treatments delivered.