Does Cocaine Have Any Potential as an Antidepressant?

Two years ago, Madeleine (not her real name) lost her father to cancer. She was devastated. She had about a gram of cocaine leftover from a New Year's Eve party, and she started using it, little by little, to get through each day. She says that cocaine is the only thing that gave her the energy to cope with her daily life, to make the funeral arrangements, and take care of her grieving mother. Cocaine, she says, saved her from her grief.

There are no doctors who would endorse Madeleine's method of self-medication—it sounds dangerously close to a rather serious habit, after all. But the fact that she says it helped her deal with depression doesn't surprise Dr. Matthew Johnson, who researches behavioral pharmacology at Johns Hopkins University.

"The idea of using cocaine, or drugs extremely similar to cocaine, for depression or related disorders is not new," he explained—and it's not scientifically unfounded either.

First, some history: Cocaine was regularly used in medicine in the late 19th and early 20th centuries as a treatment for everything from exhaustion to pain to asthma—but especially for "melancholia," or chronic sadness. In 1863, the French chemist Angelo Mariani noted that adding cocaine to wine could lift even the saddest people's spirits, and a medical text from 1885 suggested "the best results yet obtained from the administration of the drug [cocaine] have been in conditions of mental depression." In a paper presented to the American Neurological Society the same year, a physician explained how he had injected cocaine into patients who were experiencing "profound grief or sadness" to great success, and how one case of "suicidal melancholia recovered in less than one month," after only five injections of cocaine (the dose is unclear).

The most famous advocate for cocaine therapy was Sigmund Freud, who hailed the drug for its mood-enhancing properties (second only to its positive effects on one's sex drive). Freud was adamant about cocaine's potential to relieve depression; he conducted numerous experiments on himself, and noted that even "a small dose lifted me to the heights in a wonderful fashion." Freud's first major scientific contribution—before psychotherapy or free association or any of his bizarre theories about sex and psychology—was a paper praising the drug, in 1884, titled simply "On Cocaine." (It's a great time capsule from an era when doing drugs with your friends could be considered actual, bona fide research.)

By the 20th century, though, doctors and pharmacologists had realized that coke was addictive and could mess your life up. Freud himself had developed a serious coke habit, and one of his patients and friends, Ernst von Fleischl-Marxow, had died at the young age of 45, badly addicted to cocaine. If cocaine was effective in treating sadness, it could also cause a lot of misery.

Modern antidepressants don't have the same instantaneous effect as cocaine, which makes them less addictive. But they work in similar ways the brain—namely by, balancing the monoamine neurotransmitters, which are believed to be the cause of depression. Wellbutrin, a commonly prescribed antidepressant, feels similar enough to a coke binge when it's snorted that it's earned the nickname of " poor man's cocaine."

While cocaine is only vaguely similar to most modern antidepressants, it's nearly identical to another drug: methylphenidate, commonly known by the brand name Ritalin. Cocaine and Ritalin work very, very similarly—both substances block the reuptake of the same neurotransmitters in the brain to increase dopamine levels. "Snorting cocaine and Ritalin are indistinguishable to users under blind conditions," said Dr. Johnson.

Ritalin is commonly prescribed to treat ADHD, but it's also used sometimes to address "treatment-resistant depression," or cases of depression where traditional antidepressants haven't worked. "And the general consensus is that, at least for some people, these drugs are beneficial in terms of having antidepressant effects," Dr. Johnson explained.

One of the appeals of using dopaminergic stimulants to treat mood disorders is that the results are instantaneous. It can take weeks, or even months, for traditional antidepressants to kick in—which is too long for someone who's suicidal, or even someone who's dealing with intense and immediate grief. There's a Reddit thread (which, in the three months since it was posted, has made it to the "Best Of" section) about a guy who says he traveled to Mexico to buy barbiturates to kill himself. When he arrived, his cab driver gave him coke, and after a week of snorting it, he "decided life wasn't so bad after all." He believes that while cocaine didn't "cure" his depression, it saved his life.

So far, there have only been a handful of scientific studies looking into the "efficacy of dopaminergic stimulant use in patients with mood disorders," but in the small-scale studies that have been published, the results have been positive. As a 2013 review of previous research pointed out, "the abuse potential of traditional stimulants… would preclude these medications as first-line treatments for clinical depression." In other words, the possibility that you'll get addicted to coke pretty much rules it out as a medicine.

But for patients who don't have a history of substance abuse, and for whom traditional antidepressants haven't worked, the use of dopaminergic stimulants "may provide enough improvement in functional outcome to justify their use," says the review.

Again, Dr. Johnson doesn't find that surprising. "Look, I'm not recommending that anyone go out and find cocaine and use it as an antidepressant," he clarified. "But scientifically, the idea that some people have reported that cocaine has been helpful for their depression is not a crazy idea. And there is sufficient research with very related drugs that suggest that there's probably a core truth there."

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