Among cocaine-dependent patients with bipolar disorder, citicoline appears to be effective in controlling cocaine use, although these effects were attenuated over time, according to recent findings.
In a randomized, double-blind, parallel-group, placebo-controlled trial, researchers evaluated 130 outpatients with bipolar I disorder and cocaine dependency, with self-reported cocaine use within 7 days prior to baseline, and current treatment with a mood stabilizer for at least 14 days.
Participants were randomly allocated 1:1 to a treatment regimen either with citicoline (n = 61) or placebo add-on treatment (n = 61) for 12 weeks. All participants were seen weekly for evaluation, and urine samples were collected from participants 3 days a week. At each visit, patients were evaluated using the Hamilton Depression Rating Scale (HAM-D), the Young Mania Rating Scale (YMRS) and the Inventory of Depressive Symptomatology–Self Report (IDS-SR).
The primary outcome measure was the detection or lack of detection of cocaine in urine screenings. Secondary outcomes included the effects of citicoline on depressive and manic symptoms.
A generalized mixed model was applied to assess the binary outcome of cocaine-positive screens at each study examination.
The researchers found that urine screens were missing for more than half of the weeks of the study for 16.4% of patients in the citicoline group and 19.7% of the placebo patients. There were significant treatment (P = .022) and group-by-time (P = .015) effects observed, but the between-group disparities in cocaine-positive urine samples was greatest early in the study and diminished over time.
A total of 19.7% of patients in the placebo group and 23.0% of those in the citicoline group abstained from cocaine entirely. There were no significant group or group-by-time effects seen on the Cocaine Craving Questionnaire, HAM-D, IDS-SR or the YMRS. According to the researchers, the drug was well-tolerated.
“Citicoline shows promise as a treatment for cocaine use in patients with bipolar disorder, although the effects were reduced over time,” the researchers wrote. “Adequately powered trials exploring citicoline in combination with other medications that appear to decrease cocaine use, as well as in other dual-diagnosis populations, are needed. Given the lack of effect on mood symptoms, citicoline may also be effective in patients without mood disorders.” – by Jennifer Byrne
Disclosure: Brown reports receiving research grants from Forest Laboratories and Sunovion. Please see the full study for a list of all other authors’ relevant financial disclosures.