Can You Recover From Meth-Induced Psychosis?

Methamphetamine (meth) is the most common recreationally used, non-prescription stimulant besides caffeine, being used by over one million Americans each month. The action of methamphetamine on the brain stems from its ability to make chemically important messenger molecules, called monoamines, more available to communication sites on neurons.

Dopamine is one of these monoamines, and when in excess in certain parts of the brain it can cause a person to be unable to distinguish reality from fantasy.

Meth can create psychotic symptoms in an extraordinarily high percentage of its users, with an estimated 40 percent of methamphetamine users experiencing such symptoms. The most common experiences include auditory, visual and tactile hallucinations, paranoia, ideas and delusions of reference (e.g., believing a news anchor is delivering personalized messages through the TV), and delusions of persecution. These symptoms can be intense, sudden, and unpredictable.

Meth-induced psychosis belongs to a larger family of mental health conditions called substance-induced psychotic disorders. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V), the gold standard for mental health professionals for describing and diagnosing mental health conditions, a substance-induced psychotic disorder is diagnosable when the following conditions are met:

• Prominent hallucinations or delusions are present.
• Hallucinations or delusions develop during, or soon after, intoxication or withdrawal from a substance or medication known to cause psychotic symptoms.
• Psychotic symptoms are not actually part of a psychotic disorder (such as schizophrenia, schizophreniform disorder, or schizoaffective disorder) that is not substance-induced (i.e., if psychotic symptom onset was prior to substance or medication use, or persists longer than one month after substance intoxication or withdrawal, then another psychotic disorder is likely).
• Psychotic symptoms do not only occur during a delirium.

Symptoms of methamphetamine-induced psychosis can also be remarkably similar to those of psychiatric diseases like schizophrenia, and often have to be managed in emergency settings, such as intensive care units and inpatient psychiatric hospitals. Symptoms from this type of psychosis usually subside within one to two weeks of treatment. If they do not, other diagnoses need to be considered and other factors must be taken into account.

When meth-induced psychosis does not respond to treatment or subside after stopping usage, there are several potential situations to consider, with each having its own implications for management:

• Those who meet criteria for methamphetamine dependence or severe stimulant use disorder in the DSM-V are far more likely to develop psychosis with methamphetamine use and have worse outcomes.
• At least seven genes have been associated with the potential for meth use to trigger psychosis, and having those genes predicts poorer outcomes when psychosis develops.
• Using substances like methamphetamine can “unlock” a person’s genetic potential for non-substance-induced psychotic disorders like schizophrenia. This has been termed “reverse tolerance,” “sensitization,” and “priming effect.” Per the DSM-V, even if psychosis develops when using methamphetamine, it can be considered as a primary psychotic disorder if: (1) symptoms are substantially in excess of what would be expected given the type or amount of substance used or the duration of use; (2) there is a history of psychotic episodes that are not substance-related; (3) psychotic symptom onset precedes the onset of substance use; and (4) psychotic symptoms persist for at least one month after the cessation of intoxication or acute withdrawal.
• Those who have already experienced psychotic symptoms (as a result of schizophrenia or related conditions) before using methamphetamine are more likely to experience persistent psychotic symptoms.
• Finally, some researchers believe that two types of methamphetamine-induced psychosis exist, including a more severe “delayed lasting type” with symptoms that persist a month or more after stopping methamphetamine use. This form is associated with a history of methamphetamine use for five years or longer.

Acute treatment of methamphetamine psychosis symptoms often includes time-limited, low-dosage administration of second-generation antipsychotic medications like olanzapine or quetiapine, if the symptoms are distressing enough to warrant them. These medications tend to be particularly useful because their sedating effects counter the high levels of agitation that are often experienced by those with meth-induced psychosis, in addition to their primary antipsychotic effects.

In the long term, researchers believe that the most effective way to treat meth-induced psychosis is to treat the underlying substance use disorder. Though several have been studied, no medications have been approved to help treat stimulant use disorders. Cognitive behavioral therapy is a well-validated approach demonstrating excellent efficacy in reducing methamphetamine usage.