Creatine as a Treatment Option for Depression in Methamphetamine Using Females
Creatine as a Treatment Option for Depression in Methamphetamine Using Females
Methamphetamine (MA) is a psychostimulant drug with high abuse potential. MA can be smoked,
 snorted, injected or ingested orally to produce a release of high levels of dopamine into the
 brain and reduction of dopamine uptake. Its use results in feelings of pleasure, increased
 energy, and greater alertness lasting up to 12 hours. In 2010, the National Survey on Drug
 Use and Health reported that 353,000 Americans aged 12 or older reported being current MA
 users. Over the past decade MA use rates have fluctuated with current use rates on the
 decline; however, importantly, even though overall use rates are declining, use rates among
 males and females are approaching equal proportions. This use rate pattern is unlike other
 drugs of abuse, which typically demonstrate males using more than females. In some states,
 more females than males consider MA as their drug of choice. Namely, in a 2010 report in the
 state of Utah, more females were diagnosed with MA as a primary substance of abuse than males
 upon admission to treatment.

 Depression and MA use are highly comorbid. The relationship between MA use and depression is
 likely bidirectional, with MA use causing changes in mood and being used as a self-medicating
 behavior to reduce symptoms of depression. Several studies have shown that depression rates
 are higher in MA-using females compared to their male counterparts. It is likely that
 neurobiological and psychosocial mechanisms contribute to increased incidence of depressive
 symptoms in females.

 No clear treatment model exists to suggest how the comorbidity of depression and MA use is
 best managed. In studies of antidepressants for treatment of MA withdrawal and dependence,
 findings have suggested that antidepressants are ineffective for treating depressive
 symptoms.

 Creatine is an organic acid occurring naturally in vertebrates, where it takes part in energy
 homeostasis in tissues with fluctuating energy demands. Exogenous creatine has been shown to
 increase brain concentrations of PCr. Neuroimaging studies of creatine have shown increased
 brain phosphocreatine (PCr) content with creatine administration. Therefore, we hypothesize
 that oral creatine administration will increase PCr levels and reduce depressive symptoms in
 a sample of depressed female MA users. This hypothesis will be tested by a within subjects
 design by giving depressed MA using females oral creatine for eight weeks and measuring PCr
 pre- and post-treatment with magnetic resonance spectroscopy. Moreover, depressive symptoms
 will be measured by administration of the Hamilton Depression Rating Scale twice weekly
 during the course of creatine treatment.
Inclusion Criteria:

 1. Female gender, ages 18-64 years inclusive

 2. Diagnosis of MA dependence or abuse within the past 12 months, with MA preferred drug
 of abuse, identified by the SCID-I-RV

 3. Current diagnosis of Major Depressive Disorder identified by the SCID-I-RV

 4. Current HAM-D17 score of > 15

 Exclusion Criteria:

 1. Diagnosis of bipolar disorder, schizophrenia, or schizoaffective disorder, identified
 by the SCID-I-RV

 2. History of or current diagnosis of renal disease, such as chronic renal failure, acute
 renal failure or end stage renal disease

 3. Diabetes type I or II

 4. Colitis or diverticulitis

 5. Seizure disorder

 6. Current serious suicide risk identified by the Columbia Severity Suicide Rating
 Severity

 7. Current treatment with an antipsychotic, mood stabilizer, or antidepressant

 8. Positive HIV test

 9. Active Hepatitis C

 10. Contraindication to magnetic resonance scan