Relationship of prolactin response to meta-chlorophenylpiperazine with severity of drug use in cocaine dependence

Drugs currently in Phase II clinical trials for cocaine addiction

INTRODUCTION

There are no FDA-approved pharmacotherapies for treating cocaine addiction; thus, developing drugs to treat cocaine dependence is an unmet critical need. Fortunately, there are a number of drugs that are currently in Phase II clinical trial/s. This is due in part to the advances from in vivo imaging in humans which provided a roadmap of the neurochemistry of the cocaine-dependent brain. Most drugs currently in Phase II clinical trials attempt to modulate the disturbed neurochemistry in cocaine dependents to resemble those of healthy individuals. These predominantly modulate dopamine, serotonin, glutamate, GABA or noradrenaline signalling.

AREAS COVERED

This review summarizes the therapeutic potential of each drug as evidenced by clinical and preclinical studies. It also discusses their utility in terms of bioavailability and half-life.

EXPERT OPINION

Amphetamine salts and topiramate clearly stand out in terms of their potential efficacy in treating cocaine addiction. The efficacy of topiramate was closely associated with regular cognitive-behavioural therapy (CBT), which highlights the importance of a combined effort to promote abstinence and enhance retention via CBT. Cognitive/psychological screening appears necessary for a more symptom-based approach with more reasonable outcomes other than abstinence (e.g., improved quality of life) in treating cocaine addiction.

Serotonin function in pathological gambling: blunted growth hormone response to sumatriptan

Pathological gambling is a disruptive behaviour and an important public health concern that is classified as an impulse control disorder, and is also conceptualized as a prototype of 'behavioural addiction'. Its phenomenology cannot be reduced to a single neurobiological dysfunction; instead, it has been conceived as a complex chain of events in which the serotonergic system (5-HT) has often been suggested as one of the most prominent involved. Acute administration of Sumatriptan, a selective 5-HT(1B/1D) agonist, has been used to investigate the functional responsivity of 5-HT(1B/1D) receptors in alcoholics, resulting in a blunted growth hormone response. These findings have been interpreted as being due to the down-regulation of these receptors. However, previous studies could not rule out the possibility that the changes in receptor function were induced by chronic substance exposure. Twenty-two pathological gamblers and 19 healthy control subjects were evaluated in response to double-blind administration of both a single dose of oral Sumatriptan (100 mg) and of placebo in a crossover design. All participants were screened to ensure that they were negative for lifetime alcohol and drug addiction, and had been free of substance abuse for at least 6 months. Outcome measures included growth hormone, prolactin, gambling severity, mood, craving and 'high' change scales. A blunted growth hormone response was observed in pathological gamblers compared with healthy controls after Sumatriptan administration. No statistically significant differences were found for prolactin or behavioural measures, except for an increase in anxiety over time in pathological gamblers. These results, together with those obtained in our previous serotoninergic challenge study, document the presence of a serotonergic dysfunction in pathological gamblers similar to that reported in alcoholics.

The relationship between impulse-control disorders and obsessive-compulsive disorder: a current understanding and future research directions

Impulse-control disorders (ICDs) constitute a heterogeneous group of conditions linked diagnostically by difficulties in resisting "the impulse, drive, or temptation to perform an act that is harmful to the person or to others." Specific ICDs share clinical, phenomenological and biological features with obsessive-compulsive disorder (OCD) that have suggested that these disorders might be categorized together. However, other data suggest significant differences between OCD and ICDs. In this article, clinical, phenomenological and biological features of the formal ICDs are reviewed and compared and contrasted with those of OCD. Available data indicate substantial differences between ICDs and OCD that suggest independent categorizations. Existing research gaps are identified and avenues for future research suggested.

Quantitative trait locus analysis identifies rat genomic regions related to amphetamine-induced locomotion and Galpha(i3) levels in nucleus accumbens

Identification of the genetic factors that underlie stimulant responsiveness in animal models has significant implications for better understanding and treating stimulant addiction in humans. F(2) progeny derived from parental rat strains F344/NHsd and LEW/NHsd, which differ in responses to drugs of abuse, were used in quantitative trait locus (QTL) analyses to identify genomic regions associated with amphetamine-induced locomotion (AIL) and G-protein levels in the nucleus accumbens (NAc). The most robust QTLs were observed on chromosome 3 (maximal log ratio statistic score (LRS(max))=21.3) for AIL and on chromosome 2 (LRS(max)=22.0) for Galpha(i3). A 'suggestive' QTL (LRS(max)=12.5) was observed for AIL in a region of chromosome 2 that overlaps with the Galpha(i3) QTL. Novelty-induced locomotion (NIL) showed different QTL patterns from AIL, with the most robust QTL on chromosome 13 (LRS(max)=12.2). Specific unique and overlapping genomic regions influence AIL, NIL, and inhibitory G-protein levels in the NAc. These findings suggest that common genetic mechanisms influence certain biochemical and behavioral aspects of stimulant responsiveness.