Meth Detox and Withdrawal
Frequent meth use damages the signaling of the neurotransmitters serotonin, norepinephrine and dopamine. This impacts brain circuits, mood regulation and functions of self-control, motivation, cognitive performance and psychological stress. These alterations can lead to anhedonia (a permanent inability to experience pleasure), which often leads to severe depression.1
During meth detox, people experience varying symptoms linked to relapse. Anxiety and depression are the most prevalent psychiatric symptoms during meth withdrawal. Methamphetamine withdrawal syndrome is often discussed in terms of two distinctive phases. The first seven to 10 days are considered the acute phase, while the second sub-acute phase generally lasts a minimum of two weeks. In the acute phase, the worst symptoms occur within 24 hours of last use. Symptoms include increased sleeping and eating, depression, anxiety and drug cravings. After the acute phase, these symptoms subside, but still exist at lower levels.1,2
Meth users in recovery show some improvements in depression scores, however, researchers are not clear whether this is related to repairs in damaged neurotransmission or some other mechanism. A study on brain glucose metabolism in chronic meth users showed abnormalities in the same parts of the brain as mood disorders. These deficits appear to reflect regional cerebral dysfunction.1
Psychotic behavior is considered by many to be a hallmark psychiatric symptom of meth use. However, depressive symptoms are far more common and can be severe and debilitating among heavy meth users. Some of meth’s acute side effects (e.g. reduced appetite and insomnia) and withdrawal symptoms (e.g. anhedonia, depressed mood, hypersomnolence and increased appetite) overlap with symptoms of depressive disorder. A clear-cut clinical diagnosis of depression is more challenging in meth users due to these issues.3
If left untreated, depression can reduce adherence to drug treatment, increase the likelihood of relapse and elevate the risk of suicide.3 Standard depression treatment may have adverse outcomes in meth users in recovery. Selective serotonin reuptake inhibitors (SSRIs) are effective for primary depression and anxiety disorders. However, in meth users, SSRIs may be associated with cravings and increased risk of relapse during treatment and psychosocial interventions.1 While a majority of people entering treatment programs for meth abuse have levels of depression that require clinical management, a multifaceted, individualized approach is essential to prevent relapse.3 Treatments with proven efficacy include behavioral therapies (e.g. cognitive behavioral therapy and contingency-management interventions), family education, individual counseling, 12-step support, drug testing and structured activities such as exercise.4
- Bagheri M, Mokri A, Khosravi A, Kabir K. Effect of Abstinence on Depression, Anxiety, and Quality of Life in Chronic Methamphetamine Users in a Therapeutic Community. Int J High Risk Behav Addict. 2015;4(3):e23903. doi:10.5812/ijhrba.23903.
- Berman SM, Voytek B, Mandelkern MA, et al. Changes in Cerebral Glucose Metabolism during Early Abstinence from Chronic Methamphetamine Abuse. Mol Psychiatry. 2008;13(9):897-908. doi:10.1038/sj.mp.4002107.
- McKetin R, Lubman D, Lee NM, Ross JE, Slade TN. Major depression among methamphetamine users entering drug treatment programs. Med J Aust. 2011 Aug 1;195(3):S51-5.
- What treatments are effective for people who abuse methamphetamine? National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/research-reports/methamphetamine/what-treatments-are-effective-methamphetamine-abusers Updated September 2013. Accessed October 10, 2016.