Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
10.6 Major clinical issues with somatoform disorders and stimulant (including methamphetamine) use
Table of contents
- Acknowledgments
- Abbreviations
- Preface
- Introduction
- Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
1. Levels of evidence
2. Management of people with comorbidity of mental disorders and substance use- 3. The common drug groups
- 4. Tobacco
- 5. Depression and substance use
- 6. Anxiety disorders and substance use
- 7. Psychosis (schizophrenia and bipolar disorder) and substance use
- 8. Personality disorders and substance use
- 9. Eating disorders and substance use
- 10. Somatoform disorders and substance use
- 10.1 Somatoform disorders
- 10.2 Comorbidity with somatoform disorders
- 10.3 Major clinical issues with somatoform disorders and cannabis/ hallucinogen use
- 10.4 Major clinical issues with somatoform disorders and alcohol use
- 10.5 Major clinical issues with somatoform disorders and opioid use
- 10.6 Major clinical issues with somatoform disorders and stimulant (including methamphetamine) use
- 10.7 Major clinical issues with somatoform disorders and benzodiazepine use
- 10.8 Major clinical issues with somatoform disorders and inhalant/ solvent use
- 11. Gambling and substance use
- 12. Brain injury, mental disorders and substance use
- 13. Bibliography
- 14. Appendices
- If stimulants are used to treat symptoms of chronic fatigue, tolerance frequently develops with continued use, and there is a significant risk of developing dependence.
- MAO-Is (either irreversible or reversible) are contraindicated in people using amphetamines or MDMA due to risk of serotonin syndrome. Deaths have been associated with concurrent use of moclobemide and MDMA.
- Brief interventions and motivational interviewing for stimulant use are recommended.
- CBT can be used to address both the stimulant use and the somatoform disorder.
- Antidepressants may be required for comorbid depression and anxiety.
10.6.1 Effects of stimulants on somatoform disorders
- Stimulants may cause a variety of sympathetic nervous system related symptoms(421, 422) that may be confused with symptoms of somatoform disorders. However, these are generally short lived, are related to drug intoxication and resolve as drug concentrations decline.
- Evidence regarding the effect of stimulants on fatigue in patients with chronic fatigue syndrome is inconsistent(423-425). However, as symptoms are generally long lived, and tolerance to stimulants frequently develops with continued use, there is a significant risk of developing dependence.
10.6.2 Interactions between stimulants and therapeutic agents for somatoform disorders
- MAO-Is (either irreversible or reversible) are contraindicated in people using amphetamines or MDMA due to risk of serotonin syndrome (Appendix 1). Deaths have been associated with concurrent use of moclobemide and MDMAxxx(181, 182).
- Stimulant drugs are likely to exacerbate the effects of SSRI and SNRI antidepressants (and vice versa) and may result in serotonin syndrome (Appendix 1)x(127, 179, 180). Patients should be warned of signs of serotonin syndrome and be monitored.
- Fluoxetine, norfluoxetine, paroxetine and sertraline are potential inhibitors of CYP 2D6 which metabolises MDMA and methamphetamine. This may result in elevated plasma concentrations leading to toxicityx.
10.6.3 Management approaches to comorbid somatoform disorders and stimulant use
- The use of stimulants at any level should be discouraged due to the risk of dependence and most importantly the possibility of increased chances of toxicity. The patient needs to be guided towards this realisation and readiness for change determined.
- Brief interventions and motivational interviewing for stimulant use are recommended.
- CBT can be used to address both the stimulant use***(49, 183) and the somatoform disorder****(380-386).
- There are no available studies that have reported the effectiveness of CBT in managing both stimulant use and somatoform disorders.
- Use of antidepressants may be required for comorbid depression and anxiety***(406, 407) with tricyclics being useful(377), for aiding with chronic tension headaches and fibromyalgia.
- Links between the stimulant use and the particular somatoform disorder should be sought.
