JAMA Psychiatry
Generic antidepressant effective in methamphetamine use disorder
Clinical takeaway: Mirtazapine is a practical, off-label option for methamphetamine use disorder that can modestly reduce use days. Drowsiness and weight-gain side effects are tradeoffs.
In the absence of an FDA-approved treatment for methamphetamine use disorder, prescribers may have a familiar option in mirtazapine.
In this double-blind, placebo-controlled trial, 12 weeks of mirtazapine 30 mg/day led to a greater reduction in methamphetamine use than placebo: 7.0 vs. 4.8 fewer days used in the past 28 days at week 12, a 2.2-day difference. There were no unexpected safety concerns, though drowsiness and weight gain were more common with mirtazapine.
For prescribers, the appeal is straightforward: it is generic, familiar, and deliverable in routine practice, which matters in a field with no approved pharmacotherapies.
“Mirtazapine can be used in routine clinical practice to facilitate a reduction in methamphetamine use among people with a moderate to severe methamphetamine use disorder,” concluded the study.
Source: McKetin R, et al. (2026, April 1). JAMA Psychiatry. Mirtazapine for methamphetamine use disorder