A Randomized Double-Blind Controlled Trial of Creatine in Female Methamphetamine Users

Methamphetamine (MA) addiction is a public health concern that causes substantial harm to individual users, and imposes an economic burden in the U.S. totaling up to $48.3 billion annually. This study proposes to address a critical aspect of this problem: the lack of any proven, FDA-approved pharmacological treatments for MA users. The proposal combines an intervention designed to improve energy metabolism in the brain, and a neuroimaging technique capable of measuring the neurochemicals that represent cerebral bioenergetic function. The study will replicate and extend a key neuroimaging finding from the investigators recent MA studies: that MA users have decreased phosphocreatine (PCr) levels in the brain, compared to healthy volunteers. Phosphocreatine is the substrate reservoir for the creatine kinase reaction, which reversibly converts PCr into adenosine triphosphate (ATP), the brain's major energy supply, and creatine. Neuronal energy demands are met through a shift in reaction equilibrium, which is designed to maintain the concentration of ATP constant. Research results from the investigators recent study also showed that female MA users have lower brain PCr levels compared to male users. These findings join the converging lines of evidence that MA use is associated with mitochondrial dysfunction, i.e. deficient energy metabolism, in the brain. Frequently, MA users also experience depression, as well as cognitive deficits. Interestingly, both of these entities are also linked to mitochondrial dysfunction in the brain.

The long-term goal of this research program is to define the alterations in brain chemistry that underlie MA use disorders, and to utilize translational magnetic resonance spectroscopy (MRS) neuroimaging to identify rational brain-based treatment targets. Once a hypothesis-driven intervention is identified, MRS can then be further employed in treatment studies, to verify that "target engagement" is achieved. The specific aims of this proposal are an example of this stepwise scientific process: the nutritional supplement creatine will be tested in a randomized, placebo-controlled study of women with MA use disorders, to investigate creatine's effect on cerebral PCr levels, depressive symptoms, and MA usage.

Study Overview

• Status: Completed
• Conditions: Depression; Dual Diagnosis; Drug Addiction
• Intervention / Treatment: Drug: Creatine monohydrate

• Study Type: Interventional
• Enrollment (Actual): 65
• Phase: Phase 4

Contacts and Locations

Study Locations

• United States
  • Utah
    • Salt Lake City, Utah, United States, 84108
      • University of Utah

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 51 years (Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Female gender, ages 18-55 inclusive
• Current primary diagnosis of MA dependence or abuse, with MA preferred drug of abuse
• Current diagnosis of Major Depressive Disorder
• Current HAMD score > 15
• Clinical Global Impressions Severity depression score > 4
• If currently taking a psychotropic medication for depressed mood, regimen must be stable for > 4 weeks before randomization

Exclusion Criteria:

• Persons unable to provide adequate consent
• Persons who are at clinically significant suicidal or homicidal risk
• Primary substance-related diagnosis other than MA dependence or abuse
• Comorbid substance dependence diagnosis, other than nicotine (substance abuse diagnoses are not excluded)
• Positive pregnancy test
• Positive test for the antibody to the Human Immunodeficiency Virus (HIV)
• History of renal disease

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Healthy Control
Active Comparator: Creatine monohydrate; 5 grams of daily creatine monohydrate for 8 weeks	Drug: Creatine monohydrate
Placebo Comparator: Placebo; 5 g of placebo for 8 weeks	Drug: Creatine monohydrate

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hamilton Depression Rating Scale (HAMD) Scores	Change in Hamilton Depression Rating Scale (HAMD) scores will be evaluated over the course of the 8-week treatment period. The HAMD provides an indication of depression and over time provides a valuable guide to progress. Total score ranges from 0 to 54. 0 means no depression and 24 and above means severe depression.	8-weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Beck Anxiety Inventory (BAI) Scores	Change in Beck Anxiety Inventory (BAI) scores will be evaluated over the course of the 8-week treatment period. The BAI aims to assess the severity of anxiety symptoms, helping clinicians and researchers understand the level of anxiety an individual is experiencing. 0 means minimal anxiety and 30-63 means severe anxiety. The scale ranges from 0 to 63. Total score is reported.	8-weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
BL Neurochemistry Measured by Magnetic Resonance Spectroscopy	Neurochemistry, such as phosphocreatine (PCr), will be measured pre- and post-creatine/placebo treatment.	Baseline
Neurochemistry Measured by Magnetic Resonance Spectroscopy TX	Neurochemistry, such as phosphocreatine (PCr), will be measured pre- and post-creatine/placebo treatment.	8-weeks

Collaborators and Investigators

• Sponsor: Perry Renshaw
• Investigators: Principal Investigator: Perry Renshaw, MD, PhD, MBA, University of Utah

Study record dates

Study Major Dates

• Study Start: September 1, 2014
• Primary Completion (Actual): January 31, 2023
• Study Completion (Actual): January 31, 2023

Study Registration Dates

• First Submitted: July 15, 2014
• First Submitted That Met QC Criteria: July 16, 2014
• First Posted (Estimated): July 17, 2014

Study Record Updates

• Last Update Posted (Actual): April 8, 2025
• Last Update Submitted That Met QC Criteria: March 25, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders
• Other Study ID Numbers: 73034