Is Mirtazapine a Treatment Option for Amphetamine and Methamphetamine Use Disorder?

There are currently no approved pharmacological treatments for amphetamine and methamphetamine use disorder (AMD). Emerging evidence suggests that mirtazapine may be an effective treatment option; this systematic review and meta-analysis summarized that evidence.

  • Of the 206 studies screened, 2 parallel-arm randomized placebo-controlled trials were identified. These studies were conducted among cisgender men and transgender women (n=180), who received 30mg of mirtazapine (or placebo) per day.
  • These studies found a non-significant reduction in methamphetamine use after 12 weeks among patients receiving mirtazapine compared with those receiving placebo. They found no improvement in treatment retention or depression symptom severity.

Comments: Mirtazapine may reduce methamphetamine use among people with AMD, but the current evidence is inconclusive. More studies are needed to determine whether what was identified in the current study was attributable to imprecision in the effect estimate and there is indeed an effect on methamphetamine use, or if there is no benefit.

Nicolas Bertholet, MD, MSc

Reference: Naji L, Dennis B, Rosic T, et al. Mirtazapine for the treatment of amphetamine and methamphetamine use disorder: A systematic review and meta-analysis. Drug Alcohol Depend. 2022;232:109295.

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