Among adults with methamphetamine use disorder, mirtazapine delivered in routine clinical practice reduced methamphetamine use compared with a placebo, according to a
study published in
JAMA Psychiatry.
Why It’s Relevant
There is currently no approved medication to treat methamphetamine use disorder, even though it’s a
leading cause of drug-related deaths in the United States. Mirtazapine is a generic tetracyclic antidepressant that has
shown promise for reducing the use of methamphetamine among active users and is an appealing option due to its well-established safety profile.
By the Numbers
- Based in Australia, the researchers administered 30 mg per day of mirtazapine or placebo to 339 participants with methamphetamine use disorder (average age of 42, 37% female) for 12 weeks. At baseline, participants had used methamphetamine for a median of 24 of the past 28 days.
- By the end of the 12 weeks, reported methamphetamine use in the past 28 days decreased by an average of seven days in the mirtazapine group compared with baseline, while it fell by an average of 4.8 days in the placebo group.
- Mirtazapine was associated with an 8% reduction in the risk of methamphetamine use for a given day.
What’s More
More participants in the mirtazapine group reported adverse events than the placebo group, including drowsiness (47% versus 33%) and weight gain (10% versus 3%). Forty participants discontinued mirtazapine due to adverse events compared with 25 participants in the placebo group.
The Other Side
The treatment effects of mirtazapine may have been diluted in this study because the participants were heavy users, had poor medication adherence, and had high discontinuation rates.
Takeaway Message
Reducing the number of days an individual uses methamphetamine has a positive impact on functional outcomes, including decreasing the risk of methamphetamine-related psychotic symptoms, the researchers wrote. “The clinical significance of these findings lies in identifying a safe and cheap generic medication that can be prescribed to help people reduce methamphetamine use,” they added.
Related Information
Source
Rebecca McKetin, et al. Mirtazapine for methamphetamine use disorder: a randomized clinical trial. JAMA Psychiatry. Published April 1, 2026. doi: 10.1001/jamapsychiatry.2026.0159
(Image: Getty Images/iStock/Jacob Wackerhausen)