Med to Treat BP & Cocaine Cravings?
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Q:  Med to Treat BP & Cocaine Cravings?

My daughter is dual diagnosed with Bi-Polar/ADHD/Cocaine Addiction.  Recently I heard of a drug that could be used to treat Bi-Polar that also lessoned the craving for Cocaine.  Have you heard of this?  If so, could you tell me the name of the drug so I could mention it to her healthcare team. She is currently in a medical hospital due to an infection in her arm from IV drug use, and she won't be there much longer - so speed is of the essence.  Thank you very much. 

Dear Ms. W' -- 
Sorry about the delay in responding to your question (I was off at the American Psychiatric Association meeting for a week, just returned). There is one article saying lithium doesn't help; but one that says lamotrigine might help a little (here's the
abstract); and a similar one for quetiapine (Seroquel; here's that abstract). An old paper (no abstract available) commented on pramipexole for cocaine cravings; that drug has been used for severe bipolar depression in a few cases. That's about all I can find on any such connection. I use both lamotrigine and Seroquel a lot so they are very reasonable choices for bipolar treatment, depending on the main target (generally, depression or agitation/other manic symptoms, for lamotrigine and Seroquel respectively). In other words, choosing them is not choosing a weak bipolar treatment in the hopes of getting some additional benefits re: cocaine. But other bipolar medications might also work, and just not yet have been tested as these two were (in very small trials, so I wouldn't place a great deal of weight on this minimal evidence). 

Dr. Phelps

June, 2005


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