Pharmacotherapy for methamphetamine dependence: a review of the pathophysiology of methamphetamine addiction and the theoretical basis and efficacy of pharmacotherapeutic interventions.

BACKGROUND: Methamphetamine (METH) dependence is a significant public health, criminal justice, and social service concern, and although abuse of this drug spans the past 40 years in the U.S., effective treatments have only recently been developed and evaluated. Psychosocial therapies comprise the mainstay of treatment, yet many patients experience ongoing impairments in mood, cognition, emotional control, and motivation, suggesting a role for pharmacotherapy.
METHODS: A search of the literature was performed to identify drug therapies utilized with METH dependent patients and the outcome of these trials.
RESULTS: With the exception of bupropion, most trials employing direct monoamine agonists yielded negative or inclusive results, a counterintuitive finding. Positive results were produced by a trial of the mixed monoamine agonist/antagonist mirtazapine and by several studies employing indirect dopamine- and glutamate-modulating GABA agonists. Most trials were hampered by high rates of subject attrition, mirroring the difficulty in treating these patients in the outpatient setting.
CONCLUSIONS: Although considered preliminary, several therapeutic agents were identified that may prove beneficial in treating METH-dependent patients, including bupropion, mirtazapine, baclofen, and topiramate. Psychosocial therapy remains the cornerstone of treatment, and drug therapy should be regarded as an adjunct, rather than a replacement for psychosocial approaches.