Abstract
Stress plays an important role in substance abuse problems. For example, in studies with rodents stress induces reinstatement of opioid and cocaine self-administration. In addition, attenuation of the stress response by pharmacological adrenalectomy using ketoconazole, a cortisol synthesis inhibitor, reduces cocaine self-administration in rodents. In contrast, studies in primates and humans have produced conflicting results using cortisol synthesis inhibitors for attenuating cocaine-related behaviors and subjective effects. To explore the treatment implications of these findings, ketoconazole's (600-900 mg daily) ability to reduce heroin and cocaine use was compared with placebo in 39 methadone maintained patients with a history of cocaine abuse or dependence during a 12-week double blind trial. Contrary to the predicted effects, both heroin and cocaine use increased after patients were stabilized on methadone and ketoconazole. Depressive and withdrawal symptoms improved no more with ketoconazole than with placebo treatment, and side effects were greater on ketoconazole than placebo. As reported before with methadone treatment, morning cortisol levels were significantly lower than normal values throughout the clinical trial, bu...Continue Reading
References
Aug 28, 1992·Brain Research·Z SarnyaiG Telegdy
Jan 1, 1992·Journal of Substance Abuse Treatment·A T McLellanM Argeriou
Sep 15, 1992·Biological Psychiatry·T R KostenM J Kreek
Apr 1, 1991·Journal of Clinical Psychopharmacology·B E MurphyR Keller
Mar 15, 1991·Proceedings of the National Academy of Sciences of the United States of America·P V PiazzaH Simon
Dec 1, 1989·The Journal of Clinical Endocrinology and Metabolism·J H MendelsonJ Cochin
Sep 1, 1987·Peptides·R L Moldow, A J Fischman
Sep 24, 1987·The New England Journal of Medicine·N Sonino
Jan 1, 1985·The American Journal of Drug and Alcohol Abuse·T R KostenH D Kleber
Mar 1, 1995·Biological Psychiatry·A AnandL H Price
Jan 1, 1995·American Journal of Public Health·D M HartelG H Friedland
Sep 26, 1994·Brain Research·P V PiazzaH Simon
Jan 1, 1994·Drug and Alcohol Dependence·I MaremmaniP Castrogiovanni
Jul 1, 1993·Annals of Internal Medicine·E C StrainG E Bigelow
Jun 1, 1996·Psychopharmacology·Y Shaham, J Stewart
May 1, 1997·Psychoneuroendocrinology·N E Goeders
Jun 18, 1998·Psychopharmacology·Y ShahamJ Stewart
Dec 23, 1998·Behavioural Pharmacology·A S WardM W Fischman
Aug 10, 2000·Drug and Alcohol Dependence·N E GoedersG F Guerin
Aug 2, 2001·The American Journal of Psychiatry·L K JacobsenT R Kosten
Feb 1, 1960·Journal of Neurology, Neurosurgery, and Psychiatry·M HAMILTON
Citations
May 2, 2003·Psychopharmacology·David H Epstein, Kenzie L Preston
Nov 26, 2003·European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology·Wim van den Brink, Jan M van Ree
Feb 11, 2005·Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology·Lynn M OswaldGary S Wand
Apr 28, 2006·Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology·John R Mantsch, Eric S Katz
May 31, 2007·Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology·John R MantschEric S Katz
Aug 24, 2002·The European Journal of Neuroscience·Michela Marinelli, Pier Vincenzo Piazza
Mar 15, 2005·Harvard Review of Psychiatry·Bryon Adinoff
Jul 30, 2014·Regulatory Peptides·Yan Zhou, Christina Lapingo
Feb 6, 2008·Journal of Substance Abuse Treatment·Hendree E JonesGabriele Fischer
Apr 19, 2005·Alcoholism, Clinical and Experimental Research·Bryon AdinoffMark J Williams
Apr 19, 2005·Addictive Behaviors·Igor Elman, Scott E Lukas
Apr 19, 2005·Alcoholism, Clinical and Experimental Research·Bryon AdinoffMark J Williams
Jul 29, 2015·Translational Psychiatry·M WalterD de Quervain
Feb 26, 2010·The American Journal of Drug and Alcohol Abuse·Xavier CastellsMiguel Casas
Jan 13, 2012·Journal of Psychopharmacology·Anita S KablingerNicholas E Goeders
Jun 19, 2003·Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology·Debra S HarrisReese T Jones
May 8, 2021·JAMA Network Open·Brandon S BentzleyCasey H Halpern