A placebo-controlled trial of mirtazapine for the management of methamphetamine withdrawal.
OBJECTIVE
As an antidepressant with sedative and anxiolytic properties, mirtazapine may be an appropriate pharmacotherapy for methamphetamine withdrawal. This study sought to examine whether mirtazapine improves retention and alleviates methamphetamine withdrawal symptoms in an out-patient setting.


METHODS
An out-patient double-blind, randomised placebo-controlled trial of mirtazapine for the treatment of methamphetamine withdrawal was conducted (15 mg nocte for 2 days, 30 mg nocte for 12 days). Both groups were offered narrative therapy counselling. Measures recorded on days 0, 3, 7, 14 and 35 included: treatment retention, Amphetamine Cessation Symptoms Assessment, the Athens Insomnia Scale, the Brief Symptom Inventory, the Depression-Anxiety-Stress Scale (DASS), Severity of Dependence scale and the Opiate Treatment Index Drug Use subscale.


RESULTS
Thirty-one participants were recruited (18 placebo, 13 mirtazapine) and 52% completed the 2-week medication phase. No significant differences between the mirtazapine and placebo groups in retention, or any symptom measure were observed, except greater DASS-anxiety and longer sleep duration were measured at baseline among the mirtazapine group.


CONCLUSIONS
Results suggest that mirtazapine does not facilitate retention or recruitment in out-patient methamphetamine withdrawal treatment, although recruitment may have been insufficient to identify a significant treatment effect. The potential role of narrative therapy for methamphetamine dependent patients deserves further exploration.
Cruickshank
Christopher C
CC
School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA, Australia. cruicc01@tartarus.uwa.edu.au
Montebello
Mark E
ME
Dyer
Kyle R
KR
Quigley
Allan
A
Blaszczyk
Jozef
J
Tomkins
Sally
S
Shand
Diana
D
D000328:Adult; D000553:Ambulatory Care; D019969:Amphetamine-Related Disorders / Q000534:rehabilitation*; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008694:Methamphetamine / Q000009:adverse effects*; D008803:Mianserin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000078785:Mirtazapine; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000534:rehabilitation*; D013997:Time Factors
D000929:Antidepressive Agents, Tricyclic; D000697:Central Nervous System Stimulants; D008803:Mianserin; D008694:Methamphetamine; D000078785:Mirtazapine