The initial phase (crash) of withdrawal syndrome occurs as the stimulant effects wear off. Symptoms include:
depressed mood (although some irritability even in the initial phase)
some cravings (not usually severe in this initial phase).
The initial phase may last one to two days and then is followed by a longer period of several days to weeks of:
mood changeability (irritability, depression, inability to experience pleasure)
Psychotic symptoms may emerge during the first one to two weeks, particularly if they were present during times of use.
Amphetamine withdrawal is largely subjective, but may be difficult to manage, particularly for friends and family members, due to mood swings.
An inpatient setting may be necessary if the patient has significant psychotic symptoms, in which case a referral to mental health services is appropriate.
No medication has been demonstrated to be effective in alleviating amphetamine withdrawal, but some medications may be useful with some symptoms.
Antidepressants have been used for withdrawal-induced depression with some benefit, although onset of action is delayed and relapse to use while taking antidepressants can result in hypertension or serotonin syndrome. Mirtazapine is used at Drug and Alcohol Services South Australia and has resulted in some improvement in symptoms. It may be continued for depressive symptoms if response to treatment is evident.
Short-term use of benzodiazepines (diazepam 5 to 10mg QID PRN) and antipsychotics (olanzapine 2.5-5mg BD PRN) for control of irritability and agitation can be helpful, particularly in the inpatient setting. Care should be taken to limit access to large quantities of medications and to avoid development of benzodiazepine dependence. These medications should be prescribed for a maximum of seven to 10 days.
Modafinil is also used at Drug and Alcohol Services South Australia and has been demonstrated to result in some improvement in symptoms, but this is not an approved medication for amphetamine withdrawal treatment.
The mainstay of treatment is supportive care and counselling.
DACAS provides a telephone and email service for South Australian health professionals seeking clinical information and clarification around clinical procedures, guidelines and evidence-based practice.
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