Sex Differences in Progesterone Effects on Responses to Stress and Drug Cues

NCT00585520 | Completed Phase 1 DMC

• 2 other identifiers: 0609001804P50DA016556
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Cocaine dependence is a chronic, relapsing disorder in which stress/negative mood and exposure to drug-related stimuli or "cues" are associated with high rates of relapse (McKay et al., 1995; O'Brien et al., 1998; R. Sinha, 2001; Shaham et al., 2003). In particular, sex differences in relapse precipitants have been noted, with women reporting greater stress related relapses while men report higher number of relapses associated with drug cue/temptation situations (Lex, 1991; McKay et al., 1996; R. Sinha, 2001; R. Sinha, Rounsaville BJ, 2002). Current SCOR studies have shown that stress and cocaine cues increase drug craving and stress related arousal, responses that differ in cocaine men and women (R. Sinha et al., 2003; H.C. Fox et al., 2005a). Furthermore, stress-induced cocaine craving and HPA responses are predictive of cocaine relapse, which is also moderated by gender (R. Sinha et al., 2006). However, no previous research has examined the basis of sex differences in stress and cue induced craving and arousal, both of which are known to increase relapse susceptibility. Greater knowledge of the sex-specific neurobiology of cocaine dependence will facilitate development of gender-specific cocaine relapse prevention efforts. Growing evidence supports a role for gonadal hormones in explaining the sex differences observed in stress responses as well as in the behavioral responses to cocaine (Festa \& Quinones-Jenab, 2004; K. Carroll, Fenton LR, Ball SA, Nich C, Frankforter TL, Shi J, Rounsaville BJ, 2004; Lynch, 2006; Kajanti \& Phillips, 2006). Estrogen increases behavioral responses to cocaine, while presence of progesterone decreases subjective and behavioral effects of cocaine, more so in females than males (Jackson et al., 2006; Sofuogu et al., 1999; M. Sofuoglu et al., 2002; Evans \& Foltin, 2006). Stress and cocaine each enhance brain stress circuits, namely the corticotrophin releasing factor (CRF)-hypothalamic-pituitary-adrenal (HPA) axis and central noradrenergic/sympatho-adrenomedullary (SAM) pathways and both activate the mesolimbic dopaminergic systems involved in the rewarding effects of cocaine (ADD REFS). Exposure to Stress, cocaine or cocaine cues will each increase cocaine craving and HPA axis responses. Importantly, progesterone which affects behavioral responses to cocaine, also plays a key role in stress regulation. However, it is not known whether progesterone alters stress-induced and drug cue-induced craving and related stress arousal, markers that predict cocaine relapse outcomes. Our preliminary data suggest that women exposed to stress and to drug cues in the laboratory during the luteal phase (high progesterone) show lower stress induced and drug cue-induced craving, anxiety and cortisol responses compared to those in the late follicular phase (high estrogen) (see preliminary Studies section CX). On the basis of this previous research, we propose a double-blind placebo controlled study of to examine progesterone's effects on stress and cue-related responses in cocaine dependent men and women. We hypothesize that high dose of progesterone (200 mg bid) vs. placebo will alter stress-induced cocaine craving, negative affect, physiological and HPA responses to stress, and these changes will be greater in women than men.

Conditions

Cocaine Dependence

Outcome Measures

Primary Outcomes (1)

• HPA responses to stress

  5 years

Study Arms (2)

PG

ACTIVE COMPARATOR

Drug: Progesterone

PLA

PLACEBO COMPARATOR

Drug: Placebo

Interventions

Progesterone DRUG

200mg BID for 5 days

PG

Placebo DRUG

Placebo

PLA

Eligibility Criteria

• Age: 18 Years - 50 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Female and males, aged 18 to 50 years
• Able to read and write
• Meet current DSM-IV criteria for cocaine dependence; and report current cocaine use of at least once a week or more; confirmation of cocaine use via positive urine test at initial assessment and upon inpatient admission.
• For women, regular menses every 25-35 days
• In good health as verified by medical history, screening examination, and screening laboratory tests
• For women, not pregnant as determined by pregnancy screening, nor breast feeding, and using acceptable birth control methods other than hormonal contraceptives

You may not qualify if:

• History of major medical illnesses; including liver diseases, abnormal vaginal bleeding, suspected or known malignancy, thrombophlebitis, deep vein thrombosis, pulmonary embolus, clotting or bleeding disorders, heart disease, diabetes, history of stroke or other medical conditions that the physician investigator deems as contraindicated for the patient to be in the study
• Regular use of psychotropic medication (antidepressants, antipsychotics, or anxiolytics) and recent psychiatric diagnosis and treatment for Axis I disorders including major depression, bipolar affective disorder, schizophrenia or panic disorder; Meet current criteria for dependence on another psychoactive substance, excluding nicotine and caffeine; Any current use of opiates or past history of opiate abuse/dependence.
• For women, amenorrhea
• Known allergy to progesterone or peanuts (vehicle for micronized progesterone).

Sponsors & Collaborators

• Yale University: lead
• National Institute on Drug Abuse (NIDA): collaborator

Study Sites (1)

Yale University School of Medicine: Research Program on Stress, Addiction, and Psychopathology

New Haven, Connecticut, 06519, United States

Location

MeSH Terms

Conditions

Cocaine-Related Disorders

Interventions

Progesterone

Condition Hierarchy (Ancestors)

Substance-Related Disorders; Chemically-Induced Disorders; Mental Disorders

Intervention Hierarchy (Ancestors)

Pregnenediones; Pregnenes; Pregnanes; Steroids; Fused-Ring Compounds; Polycyclic Compounds; Corpus Luteum Hormones; Gonadal Hormones; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Progesterone Congeners; Gonadal Steroid Hormones

Study Officials

• Rajita Sinha, PhD

  Yale University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: December 25, 2007
• First Posted: January 3, 2008
• Study Start: September 1, 2007
• Primary Completion: September 1, 2013
• Study Completion: September 1, 2013
• Last Updated: February 12, 2014

Record last verified: 2014-02

Locations

US (1)