Clinical management of psychostimulant withdrawal: review of the evidence

Abstract

It is estimated that a majority of people who use psychostimulants, particularly methamphetamine (MA) and cocaine, experience withdrawal upon abstinence from sustained use. This review of clinical research reports the evidence regarding biomedical and behavioral treatments for psychostimulant withdrawal symptoms. It provides a framework for clinicians and scientists to increase impact on attenuating MA and cocaine withdrawal during initial and sustained abstinence. Articles reviewed included reports of controlled clinical trials (randomized or non‐randomized) reporting at least one withdrawal symptom among the outcomes or specifically studying patients in withdrawal. Potential efficacy for MA withdrawal is noted for a few medications (mirtazapine, naltrexone, bupropion) and repetitive transcranial magnetic stimulation during acute (first week), early protracted (weeks 2–4) and late protracted (> 4 weeks) withdrawal phases. Topiramate shows mixed evidence of efficacy for cocaine withdrawal. In general, there is inconsistent signal for biomedical and behavioral treatments on MA and cocaine withdrawal.

Withdrawal from 3‐Fluoroethamphetamine induces hyperactivity and depression‐like behaviors in male mice

“…Amphetamine withdrawal symptoms mainly increase appetite, anxiety, attention deficit disorder, hyperactivity disorder, dysphoria, severe depression accompanied by suicidal ideation, and impulsivity (Li & Shoptaw, 2023; Shoptaw et al, 2009). Therefore, to evaluate relevant behaviors, we performed the open field, elevated plus maze, cliff avoidance, and forced swim tests in rodents (Paulson et al, 1991; Peterson et al, 2003).…”

COT-TT vaccine attenuates cocaine-seeking and cocaine-conditioned place preference in rats

“…Cocaine is a psychostimulant, powerful, addictive drug and is considered one of the most consumed and popular illicit drugs and is responsible for important medical, psychiatric, and social problems throughout the world. 1 , 2 Cocaine use disorder (CUD) is a psychiatric disorder characterized by compulsive and repetitive use of cocaine, a high rate of relapse, a significant rate of psychiatric and somatic comorbidity, and limited treatment options available approved by the FDA, making CUD a serious global public health problem. 3–5 …”