From the Guidelines
Treatment of methamphetamine withdrawal primarily involves supportive care in a structured environment, focusing on managing symptoms such as agitation, sleep disturbance, and depression, without specific medication recommended for the withdrawal itself. According to the World Health Organization's guidelines for mental, neurological, and substance use disorders 1, withdrawal from amphetamines, including methamphetamine, is best undertaken in a supportive environment. The management approach should include relief of symptoms, such as agitation and sleep disturbance, which may be achieved with symptomatic medication for the period of the withdrawal syndrome.
Key aspects of care include:
- Monitoring in a structured environment, either inpatient or outpatient, depending on the severity of withdrawal
- Regular assessment of vital signs, hydration status, and mental health
- Symptomatic treatment for agitation, sleep disturbances, and depression as needed
- Consideration of psychosocial support to address the underlying issues contributing to substance use
For severe symptoms, such as agitation or psychosis, short-term use of medications like benzodiazepines or antipsychotics may be considered, but this should be done under close supervision and with caution due to the potential for adverse effects or dependency. Similarly, for depression, selective serotonin reuptake inhibitors (SSRIs) may be useful, but the primary approach should remain focused on supportive care and management of withdrawal symptoms. Behavioral interventions, including cognitive-behavioral therapy and support groups, play a crucial role in the recovery process, especially in addressing the long-term effects of methamphetamine use on dopamine pathways and reducing cravings 1.
From the Research
Treatment for Methamphetamine Withdrawal
- There are no evidence-based withdrawal treatments, and no medication is approved for the treatment of methamphetamine withdrawal 2, 3
- Lisdexamfetamine has been studied as a potential agonist therapy to ameliorate withdrawal symptoms and improve outcomes for patients 2
- A novel treatment protocol comprising behavior-targeted and pharmacological components has been developed to reduce the intensity and duration of methamphetamine intoxication and withdrawal-related symptoms during early treatment 4
- Pharmacological interventions, including ascorbic acid, antipsychotics, and other sedatives, have been discussed as potential treatments for methamphetamine withdrawal 4
Symptoms of Methamphetamine Withdrawal
- Depressive and psychotic symptoms accompany acute withdrawal from methamphetamine but resolve within 1 week 5
- Craving for methamphetamine is present and lasts at least 5 weeks 5
- Withdrawal symptoms have been linked to a propensity for relapse to drug abuse 5
Studies on Methamphetamine Withdrawal Treatment
- A systematic review and meta-analysis of randomized controlled trials found insufficient evidence to indicate any medication is effective for the treatment of methamphetamine withdrawal 3
- A pilot clinical trial tested a controlled d-amphetamine withdrawal paradigm among methamphetamine-using individuals and found that craving for methamphetamine increased during weeks 2-3 in the placebo group relative to those on d-amphetamine 6
- A study found that amineptine may reduce discontinuation rates and improve global state compared with placebo, but this medication is no longer approved 3