Persian was selected as another language for the inclusion of the abstracts and papers in this study, especially for searching in Iranian journals databases. The diagnosis of an amphetamine problem (abuse, dependence or use disorder) needed to be confirmed according to a validated measure such as different versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD). Randomised clinical or controlled trials (RCTs) were selected if they were related to one of the study aims. Any type of pharmacological treatment for an amphetamine problem was acceptable for study inclusion. BCBT needed to be conducted in agreement with the principles of Baker and colleagues’ treatment guide 9. BCBT refers to teaching patients to identify, evaluate and respond to their dysfunctional thoughts and beliefs and use a number of techniques to change thinking, mood and behaviours in less than ten session of psychotherapy 9.
Health Challenges
- Volkow and colleagues have performed an enormous body of research using PET and other brain imaging techniques to explore the relationship between DAT occupancy, synaptic dopamine concentration and dopamine D2 receptor occupancy for psychostimulant drugs of abuse.
- The desired goal of pharmacotherapy will likely vary depending on the patient, and must be patient-focused and clinically relevant.
- There were 75 distinct secondary outcomes inclusive of variations and often analysed differently to the primary outcomes of the same domain.
- In another study (Cruickshank 2008), participants were administered 15 mg of mirtazapine on the first two nights and 30 mg mirtazapine every night for the next 12 nights.
- Following a 3-week, open-label run-in period where the dose of MES-amphetamine XR was optimised to 10, 20 or 30 mg once a day, subjects were then randomised into a 3-way double-blind, placebo-controlled crossover trial.
On the primary and secondary efficacy variables of behaviour, attention and problem solving, lisdexamfetamine delivered equivalent or better efficacy than MES-amphetamine XR with both drugs being maximally effective at 2 h post-dose (Biederman et al., 2007a). However, on the problem-solving endpoints, it was also evident that lisdexamfetamine maintained its maximum effect for at least 12 h, whereas the effect of MES-amphetamine XR showed a clear decline after 6–8 h (Biederman et al., 2007a). A post-hoc analysis of the data also showed that the sex and age of the subjects had no significant influence on the efficacy of lisdexamfetamine (Wigal et al., 2010b). The primary action of amphetamine is to increase synaptic concentrations of monoamine neurotransmitters, thereby indirectly enhancing noradrenergic, dopaminergic neurotransmission in the CNS. Although amphetamine’s isomers are also powerful 5-HT-releasing agents in vivo (Heal et al., 1998; Kuczenski et al., 1995), this action does not appear to contribute to their efficacy in treating ADHD. This opinion is based on clinical experience with fenfluramine, which is a chemical analogue of amphetamine and a powerful releasing agent with a preferential action on 5-HT (Baumann et al., 2000; Gundlah et al., 1997; Tao et al., 2002).
Types of amphetamines
You should take FDA-approved amphetamines orally (by mouth) as directed by your healthcare provider. NL had the idea for this systematic review; KJS, LSA, NL, and NE designed the study; KJS and LSA performed the literature search and data analyses; KJS drafted the first manuscript; LSA, NL and NE critically revised the manuscript. A summary of the reviewed studies is presented in Table 4, and an extended version is available in Supplementary Table 1 (see ESM). In addition, the data collected by both reviewers can be located in its entirety in the Supplementary Data (see ESM). We approached this report as a systematic review of the peer-reviewed literature, and present the methods and results in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement 22.
Preventing drug misuse in children and teenagers
Furthermore, data were inadequate to measure effect sizes for some outcome measures. No studies were located that analysed treatment outcomes by gender, although the importance of gender differences and treatment outcomes have been reported in the research literature 28, 29. Papers needed to be published either in English or have a published abstract in English.
What Are the Treatment Options for Amphetamine Addiction?
Tolerance develops slowly, but amounts several 100-fold greater than the amount originally used may eventually be ingested or injected. Tachycardia and increased alertness diminish, but hallucinations and delusions may occur. Amphetamines are sympathomimetic drugs with central nervous system stimulant and euphoriant properties whose toxic adverse effects include delirium, hypertension, seizures, and hyperthermia (which can cause rhabdomyolysis and renal failure). Toxicity is managed with supportive care, including IV benzodiazepines (for agitation, hypertension, and seizures) and cooling techniques (for hyperthermia). Two reviewers participated in searching the literature (M.E and A.M; the firth author). Studies including titles and abstracts identified by electronic searches were assessed and screened by one author (M. E).
“Doctors are going to be reading about it and may prescribe the medications off-label to their patients,” Volkow says. Volkow says one theory is that naltrexone reduced physiological cravings for meth, while buproprion’s “antidepressant effects” eased the anxiety people experience when they stop using. A comparison of the mean peak increases in systolic and diastolic blood pressure produced by intravenous versus oral administration of 50 mg lisdexamfetamine.
Some studies have suggested about 30% of patients with amphetamine-induced psychosis end up with a primary psychosis over time. Four studies, involving 125 participants, met Amphetamine Addiction the inclusion criteria for this review (seeCharacteristics of included studies). In total, 59 participants received treatment for amphetamine withdrawal (37 amineptine, 22 mirtazapine) compared to 66 participants who received placebo. Few studies examined treatments for amphetamine withdrawal, although it is a common problem among amphetamine users. Its symptoms, in particular intense craving, may be a critical factor leading to relapse to amphetamine use.
Treatment
- Patients received injections of extended-release naltrexone and oral doses of bupropion.
- It is also important to give a healthcare professional all the facts so that they can work with a person to develop the best possible treatment plan for them as an individual.
- Depending on what type and the dosage of the prescribed amphetamine, take extended-release capsules once daily and immediate-release tablets and oral solutions up to three times per day.
- Across all studies, allocation of participants was by random assignment, and all but three studies 46, 56, 66 were double-blind.
- Another key area that has not been adequately addressed in clinical trials is the issue of comorbid sleep disturbances in patients using AMPH/MA, and the likely impact upon the role of different medications.
- In summary, the results showed some benefits of amineptine in the treatment of amphetamine withdrawal, as seen in the discontinuation rate and improvements in the global state as measured by CGI.
Mansour Khoramizadeh designed the study and conributed to approving the study. Mohammad Effatpanah, Alireza Mostaghimi, Mehdi Rezaei and Alireza Mahjoub contributed to searching and conducting the systematic review. Unclear risk was identified in one study 23 due to insufficient description of group allocation. Symptoms could last between one to three days or up to 10 days after stopping an amphetamine. The U.S. Food and Drug Administration approved certain amphetamines to manage and treat ADHD, obesity and narcolepsy, specifically dextroamphetamine and levoamphetamine.
- In this course, participants explore the multifaceted management of amphetamine toxicity.
- L-Amphetamine releases noradrenaline, dopamine and 5-HT from synaptosomes (Heikkila et al., 1975; Holmes and Rutledge, 1976) and noradrenaline and dopamine from rat brain slices (Easton et al., 2007).
- Furthermore, using pharmacological treatments combined with BCBT is applicable to a broad range of patients due to the practical techniques and skills that such therapies impart to patients 10.
Sensitivity analysis is an analysis used to determine how sensitive the results of a study or systematic review are to changes in how it was done. Sensitivity analyses are used to assess how robust the results are to uncertain decisions or assumptions about the data and the methods that were used. Other than raw data (e.g. death), the outcomes derived from only valid scales were included in the reviews. In this review, a valid scale means a scale that has been published in a scientific journal.
One priority for clinicians and researchers alike has been to establish an effective pharmacotherapy for SUD. Target pharmacotherapies have considered the mechanism of action of AMPH/MA, which affects neurotransmitters through a number of mechanisms. Consumption of MA triggers a cascading release of norepinephrine, dopamine and serotonin. The drug (to a lesser extent) acts as a dopaminergic and adrenergic reuptake inhibitor, and in higher concentrations as a monoamine oxidase inhibitor (MAOI) 1, 21. The CNS effects produced by MA are mostly the result of influencing levels of dopamine and norepinephrine, and to a lesser extent serotonin 1, 21. While its behavioral and physiological effects are similar to those of cocaine, there are some major differences in the basic mechanisms of how these drugs work at the cellular level.