Because current studies have small sample sizes and limited controls, firm conclusions or treatment recommendations cannot be made at present, but pharmacologic approaches probably have a place in the treatment of cocaine abuse. Pharmacologic treatments of cocaine abusers may relate to underlying psychiatric diagnoses. Cocaine abusers with adult attention deficit disorder appear to respond well to methylphenidate, but other cocaine abusers have increased cocaine craving when getting this medication. Cyclothymic cocaine abusers appear to respond to lithium with reduced cocaine use. Depressed cocaine abusers, who may constitute about 30 per cent of abusers, have decreased cocaine craving and increased abstinence when treated with desipramine. Other cocaine abusers without underlying psychiatric disorders may also respond well to desipramine if they fail to reduce their cocaine use during psychotherapy.
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