A review of treatment options for co-occurring methamphetamine use disorders and depression
Open accessAbstract
Co-occurring methamphetamine use and depression interferes with treatment outcomes. Female methamphetamine users are known to have higher rates of depression than male methamphetamine users, although this is also true for the general population. There are limited treatment options for the management of depression among methamphetamine users. In this integrative review, we summarize data on treatment strategies for co-occurring depression and methamphetamine use disorders. English-language articles were identified from PsychINFO, CINAHL, PubMed, and Medline as well as from reference lists of key articles. Search terms included "methamphetamine," "depression," and "treatment." Research articles describing psychological (n = 3), pharmacological (n = 6), nutritional supplement (n = 1), and psychological combined with pharmacological (n = 3) approaches for the treatment of methamphetamine use or withdrawal and/or depression are included in this review. Psychological and combination of psychological with pharmacological approaches have not been shown to be effective in treating these co-occurring conditions. Antidepressants have been determined to be ineffective and/or to introduce side effects. Gender differences with response to treatment were examined in only one of the published studies. There is a large gap in knowledge regarding treatment of co-occurring methamphetamine use disorders and depression. Considering that female methamphetamine users experience higher rates of depression than men, a focus on gender-specific treatment approaches is warranted.
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Methamphetamine use, when regular, is associated with harms including injecting and sexual risk-taking behaviour, symptoms of mental ill health (psychosis, aggression, depression, anxiety), psychomotor, social and cognitive impairment, criminal activity, and sometimes death by overdose.
“Methamphetamine (MA) is a psychostimulant that when used regularly is associated with harms such as injecting and sexual risk-taking behaviour, symptoms of mental ill health (eg, psychosis, aggression, depression and/or anxiety), psychomotor, social and cognitive impairment, criminal activity and sometimes death caused by overdose.1–7”
From Protocol for a systematic review of psychological treatment for methamphetamine use: An analysis of methamphetamine use and mental health symptom outcomes (2017) · cites this paper as [4]
The Abstract (page not provided) describes methamphetamine as a stimulant and lists depression and anxiety among the effects of abuse. The passages do not establish the other attributed harms: injecting or sexual risk-taking, psychosis, aggression, psychomotor, social or cognitive impairment, criminal activity, or fatal overdose. (LLM, conf=0.86)
Experimental — accuracy not yet measuredHellem et al conducted a review on methamphetamine and coexisting depressive symptoms, reviewing nine studies incorporating psychological intervention only, psychological combined with pharmacological interventions, and pharmacological only.
“Hellem et al 4 conducted a review on MA and coexisting depressive symptoms, reviewing nine studies incorporating psychological intervention only; psychological combined with pharmacological interventions; and pharmacological only, and found no research supporting one single treatment approach over others on either MA or depression outcomes.”
From Protocol for a systematic review of psychological treatment for methamphetamine use: An analysis of methamphetamine use and mental health symptom outcomes (2017) · cites this paper as [4]
The Results section identifies psychological-only, pharmacological-only, and combined approaches, and the Conclusion says no clear treatment model exists for co-occurring depression and methamphetamine use disorders. But the Discussion says the review yielded 13 publications, not nine; the Results also identifies a nutritional-supplement trial omitted from the citing sentence. Page numbers were not available in our copy. (LLM, conf=0.91)
Experimental — accuracy not yet measuredHellem et al found no research supporting one single treatment approach over others on either methamphetamine or depression outcomes.
“Hellem et al 4 conducted a review on MA and coexisting depressive symptoms, reviewing nine studies incorporating psychological intervention only; psychological combined with pharmacological interventions; and pharmacological only, and found no research supporting one single treatment approach over others on either MA or depression outcomes.”
From Protocol for a systematic review of psychological treatment for methamphetamine use: An analysis of methamphetamine use and mental health symptom outcomes (2017) · cites this paper as [4]
The Conclusion (page unavailable) says no clear treatment model exists for optimally managing co-occurring depression and methamphetamine use disorders, supporting the claim that no approach was established as best. However, the Results (page unavailable) describe 13 publications across psychological, pharmacological, combined, and nutritional-supplement approaches—not nine studies in the three categories the citing sentence lists. (LLM, conf=0.88)
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“In 2 RCTs in which up to 300 mg/day bupropion was given over 12 weeks, no alleviation of depression or anxiety symptoms was observed compared to placebo [9, 11, 55, 56].”
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Jiang, P., Sun, J., Zhou, X., Lu, L., Li, L., Huang, X., Li, J., Kendrick, K. M., & Gong, Q. (2021) · Human Brain Mapping · doi:10.1002/hbm.25439 · Cited by 35 · see citing works
“This could possibly explain why no pharmacological approaches to date have been found to be effective in treating anxiety (Hellem, 2016) or depressive (Hellem et al., 2015) symptoms in MAs, while antidepressant medications can help in reducing METH use (Siefried, Acheson, Lintzeris, & Ezard, 2020).”
BackgroundMethamphetamine-Related Disorders
Gouzoulis‐Mayfrank, E., Härtel-Petri, R., Hamdorf, W., Havemann‐Reinecke, U., Mühlig, S., & Wodarz, N. (2017) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2017.0455 · Cited by 33 · see citing works
Correlates of anxiety and depression in a community cohort of people who smoke methamphetamine
Duncan, Z., Kippen, R. J., Sutton, K., Ward, B., Agius, P. A., Quinn, B., & Dietze, P. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674211048152 · Cited by 31 · see citing works
“For those who use methamphetamine and have anxiety and/or depression, successfully engaging with professional support can be difficult (Glasner et al., 2010; Hellem et al., 2015).”
BackgroundGender Differences in Sleep Problems Among Drug Users
He, H., Tang, J., Liu, T., Hao, W., & Liao, Y. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00808 · Cited by 27 · see citing works
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“An additional review of treatment options specific to MA users presenting with depression reveals a large gap in knowledge of effective, sustainable treatment options whether treatment options are psychological approaches, pharmacological approaches or both [31].”
BackgroundHartwell, E. E., Moallem, N. R., Courtney, K. E., Glasner, S. V., & Ray, L. A. (2016) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000000250 · Cited by 23 · see citing works
“Understanding the specific trajectories and behaviors that differentiate men from women in their responses to negative affect may be valuable as a means of designing much needed sexspecific interventions (Hellem et al., 2015).”
Chen, Y., Zhang, J., & Sun, Y. (2019) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2019.06.003 · Cited by 24 · see citing works
Gogarnoiu, E. S., Vogt, C. D., Sanchez, J., Bonifazi, A., Saab, E., Shaik, A. B., Soler‐Cedeño, O., Bi, G., Klein, B., Xi, Z., et al. (2023) · Journal of Medicinal Chemistry · doi:10.1021/acs.jmedchem.2c01624 · Cited by 22 · see citing works
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Exploring psilocybin-assisted psychotherapy in the treatment of methamphetamine use disorder
Brett, J., Knock, E., Korthuis, P. T., Liknaitzky, P., Murnane, K. S., Nicholas, C. R., Patterson, J. C., & Stauffer, C. S. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1123424 · Cited by 16 · see citing works
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“Some researchers support pharmacological approaches to treat METH use or withdrawal and/ or depression, while others favour non-pharmacological therapies, such as CBT and mindfulness therapy [22].”
BackgroundU.S. trends in methamphetamine-involved psychiatric hospitalizations in the United States, 2015–2019
Calcaterra, S. L., Yamkovoy, K., Swathi, P. A., Ciccarone, D., del Pozo, B., Englander, H. L., Wang, J., & Barocas, J. A. (2024) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2024.111409 · Cited by 14 · see citing works
The Role of Affect in Psychosocial Treatments for Substance Use Disorders
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Koriem, K. M. M., & El-Qady, S. W. B. (2023) · NeuroToxicology · doi:10.1016/j.neuro.2023.09.007 · Cited by 7 · see citing works
How does methamphetamine affect the brain? A systematic review of magnetic resonance imaging studies
Liu, G. X. H., Tayebi, M., Bristow, B., Wang, J., Lin, Y., Newburn, G., Condron, P., McHugh, P., Schierding, W. S., Holdsworth, S. J., et al. (2025) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2025.112862 · Cited by 5 · see citing works
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Gender differences in sleep quality among Iranian traditional and industrial drug users
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“…quality between men and women who use synthetic drugs this may be due to the gender-specific role of certain genes in industrial drug use disorder (Hellem et al., 2015) or the fact that this group of women experiences higher rates of depression than their counterparts in other groups (AlRyalat et…”
BackgroundAmaro, H. D. L. A., Kong, Y., Marsh, J. C., Khachikian, T., & Guerrero, E. G. (2023) · Evaluation and Program Planning · doi:10.1016/j.evalprogplan.2023.102240 · Cited by 4 · see citing works
“, depression, bipolar) and stress-related disorders (e.g., posttraumatic stress disorder; Grella et al., 2009; Hellem et al., 2015; McHugh et al., 2013).”
BackgroundKoriem, K. M. M., & Naiem, A. H. A. (2025) · Toxicology Reports · doi:10.1016/j.toxrep.2025.101936 · Cited by 3 · see citing works
“These results are consistent with those of several studies, like Hellem et al. [44], found female METH have higher depression than male METH users.”
Benito, A., Jiménez‐Múrcia, S., Tirado-Muñoz, J., & Adán, A. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15020730 · Cited by 3 · see citing works
“As Hellem et al. [76] point out in their review, there is a significant knowledge gap regarding the treatment of methamphetamine use disorder and comorbid depression.”
Disorders due to Substance Use: Stimulants
Sevarino, K. A., & Farrell, M. (2024) · Springer eBooks · doi:10.1007/978-3-030-51366-5_26 · Cited by 3 · see citing works
Salemi, S., Abdoli, N., Farnia, V., Tatari, F., Shakeri, J., Basanj, B., AhmadiJuibari, T., & Bahrampouri, S. (2018) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_153_17 · Cited by 2 · see citing works
Kiyani, A. R. T., Zhang, X. Y., Bashir, M., Saad, U., & Wang, D.-M. (2026) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-025-02146-1 · Cited by 1 · see citing works
“Over the past few years, scholars and scientists have emphasized the consideration of MA as a treatment to deal with depression [29].”
Zhou, S., Ran, W., Peng, C., Tong, S., Hong, L., Cai, F., Jin, W., Jiang, Y., Li, M., Wang, X., et al. (2022) · Research Square · doi:10.21203/rs.3.rs-1209591/v1 · Cited by 1 · see citing works
Ahmadkhaniha, H., Alavi, K., Rouhi, E., & Najarzadegan, M. R. (2016) · international journal high risk behaviors & addiction · doi:10.5812/ijhrba.29749
“On the other hand, due to the high comorbidity of depressive symptoms in people who abuse methamphetamine, it is hypothesized that the risk of other psychiatric disorders may underlie addiction or relapse of methamphetamine use (17).”
BackgroundHellem, T., Scholl, L. S., Sung, Y., Ferguson, H., McGlade, E., Yurgelun-Todd, D. A., Renshaw, P. F., & Hildreth, L. A. (2017) · Journal of Dual Diagnosis · doi:10.1080/15504263.2017.1356493
“Although trained personnel administered the SCID-IV and PRISM, evidence suggests that assessing psychiatric illness in the presence of an ongoing substance use disorder can be complicated by symptoms of intoxication and withdrawal (Stein et al., 2004; Langa s et al., 2011; Wynn, Landheim, & Hoxmark, 2013).”
BackgroundMethodResultInfluentialPsychische Komorbidität bei Crystalkonsumenten
Braunwarth, W., Härtel-Petri, R., Hamdorf, W., Fleischmann, H., Havemann‐Reinecke, U., Jeschke, P., Looser, W., Mühlig, S., Gouzoulis‐Mayfrank, E., Schäfer, I., et al. (2018) · NeuroTransmitter · doi:10.1007/s15016-018-6421-x
Psychosocial treatment for methamphetamine use and the associated mental health symptoms
Mann, A., & Wagstaff, C. (2019) · Advances in Dual Diagnosis · doi:10.1108/add-11-2018-0022
Wodarz, N., Christ, M., Fleischmann, H., Looser, W., Schoett, K., Vilsmeier, F., Krampe-Scheidler, A., Schaefer, C., Bothe, L., Mühlig, S., et al. (2019) · SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice · doi:10.1024/0939-5911/a000615
Ahmadkhaniha, H., Alavi, K., Rouhi, E., & Najarzadegan, M. R. (2018) · international journal high risk behaviors & addiction · doi:10.5812/ijhrba.64561
Salimi, H., Haghighi, A. H., Ababzadeh, S., Marefati, H., Abbasian, S., Pond, A. L., & Gentil, P. (2023) · European Journal of Translational Myology · doi:10.4081/ejtm.2023.12112
Disorders Due to Substance Use: Stimulants
Sevarino, K. A., & Farrell, M. (2023) · Springer eBooks · doi:10.1007/978-3-030-42825-9_26-1
He, H., Zhou, S., Peng, C., Ran, W., Tong, S., Hong, L., Cai, F., Jin, W., Jiang, Y., Li, M., et al. (2022) · Figshare · doi:10.6084/m9.figshare.20115737
Medical Symptoms and Psychiatric Comorbidities in People with Methamphetamine Use Disorder
Marín-Navarrete, R., Sánchez-Domínguez, R., Fernández-Cáceres, C., & Saracco-Álvarez, R. A. (2026) · Journal of Dual Diagnosis · doi:10.1080/15504263.2026.2686086
“At the same time, depressive disorder is the second most prevalent disorder in this population (Conway & al, 2006) mainly affecting women (Hellem et al., 2015), possibly because methamphetamine use can help alleviate depression symptoms.”
Kiyani, A. R. T., Saad, U., Tian, Y., Chen, M., Wang, D.-M., & Zhang, X. (2026) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-026-02371-2
BindingDB Entry 50020610: Dopamine D
BindingDB (2024) · UC San Diego · doi:10.7270/q2m90f4g
- Authors
- Hellem, T. L., Lundberg, K. J., & Renshaw, P. F.
- Affiliations
- University of Utah (US)
- Corresponding author
- Hellem, Tracy L.
- Venue
- Journal of Addictions Nursing
- Published
- 2015-01
- Volume
- 26
- Issue
- 1
- Pages
- 14-23
- ISSN
- 1088-4602 (ISSN-L)
- PMC
- PMC5510330
- OpenAlex
- W2326871892
- Cited by
- 51
- References
- 68
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 7 · 2023: 6 · 2022: 4 · 2021: 3 · 2020: 5 · 2019: 5 · 2018: 4 · 2017: 5 · 2016: 5 · 2015: 1
- FWCI
- 0.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Addictions Nursing (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (DA-031247, K05DA031247)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- methamphetamine dependence, depression, co-occurring disorders, treatment options, antidepressants, antidepressant side effects, psychological intervention, dietary supplements, gender differences, methamphetamine withdrawal
- MeSH terms
- Central Nervous System Stimulants, Antidepressive Agents, Clinical Trials as Topic, Combined Modality Therapy, Depressive Disorder, Female, Humans, Male, Methamphetamine, Cognitive Behavioral Therapy, Diagnosis, Dual (Psychiatry), Amphetamine-Related Disorders
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