Background
Cocaine dependence involves problematic neuroadaptations that might be responsive
to modulation of glutamatergic circuits. This investigation examined the effects of
subanesthetic ketamine infusions on motivation for quitting cocaine and on cue-induced
craving in cocaine-dependent participants, 24 hours postinfusion.
Methods
Eight volunteers with active DSM-IV cocaine dependence not seeking treatment or abstinence
were entered into this crossover, double-blind trial. Three 52-min intravenous infusions
were administered: ketamine (.41 mg/kg or .71 mg/kg) or lorazepam 2 mg, counterbalanced
into three orderings in which ketamine .41 mg/kg always preceded the .71 mg/kg dose.
Infusions were separated by 48 hours, and assessments occurred at baseline and at
24 hours postinfusion. Outcomes were change between postinfusion and preinfusion values
for: 1) motivation to quit cocaine scores with the University of Rhode Island Change
Assessment; and 2) sums of visual analogue scale craving ratings administered during
cue exposure.
Results
Compared with the active control lorazepam, a single ketamine infusion (.41 mg/kg)
led to a mean 3.9-point gain in University of Rhode Island Change Assessment (p = .012), which corresponds to an approximately 60% increase over preceding values.
There was a reduction of comparable magnitude in cue-induced craving (p = .012). A subsequent ketamine infusion (.71 mg/kg) led to further reductions in
cue-induced craving compared with the control. Infusions were well-tolerated.
Conclusions
Subanesthetic ketamine demonstrated promising effects on motivation to quit cocaine
and on cue-induced craving, 24 hours postinfusion. Research is needed to expand on
these preliminary results and to evaluate the efficacy of this intervention in clinical
settings.
Key Words
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Article info
Publication history
Published online: September 16, 2013
Accepted:
August 8,
2013
Received in revised form:
August 6,
2013
Received:
February 14,
2013
Identification
Copyright
© 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
