Drugs that stimulate the central nervous system to increase levels of mental and physical energy and alertness and produce an elevated mood; also known as psychostimulants.
Stimulants are psychoactive drugs used for the treatment of certain psychiatric conditions, and also to enhance energy levels, maintain wakefulness, and encourage weight loss. Some are also used, and often abused, for recreational purposes. Stimulants are noted for inducing temporary improvements in mental and physical functioning. These drugs include prescription drugs or over-the-counter medications, illegal street drugs, or ingredients in commonly ingested substances such as the caffeine in coffee or the nicotine in tobacco. Whatever the form, stimulants increase respiration, heart rate, and blood pressure, and abuse may result in adverse physical and mental effects and endanger an individual's health. In certain circumstances, the use of stimulants may even threaten life. An overdose of stimulants may result in chest pains, convulsions, paralysis, coma, and death.
Therapeutic use of stimulants
The clinical or medical use of stimulants is directed toward treating a range of physical and mental disorders, including the following:
- Correcting lethargy, fatigue, narcolepsy and sleepiness
- Decreasing appetitie and promoting weight loss
- Improving concentration and focus, reducing restlessness and hyperactivity
- Treating depression and bipolar disorder
- Treating orthostatic hypotension and postural orthostatic hypotension
- Smoking cessation
- Offsetting the effects of long-term opiod use
- Relieving headache associated with use of other drugs or stimulants
Stimulants have long been used to treat psychological disorders. Although psychiatrists have used certain stimulants as antidepressants, this practice is limited primarily to seriously depressed patients who have failed to respond to either psychotherapy or to the wide range of newer antidepressants, as well as for treating bipolar depression. One of the primary therapeutic uses of stimulants is for the treatment of attention deficit/hyperactivity disorder (ADHD) in children. The most widely used stimulants include methylphenidate, amphetamine, and substituted phenethylamines (Ritalin, Metadate, Concerta) and dexmethylphenidate (Focalin). These drugs work by facilitating the release of the neurotransmitter norepinephrine to improve alertness, attention span, and ability to focus. However, while methylphenidate and related drugs are generally considered safe and effective for the treatment of ADHD in children and adolescents, controversy still exists about the frequency with which these medications are prescribed. Side effects may include insomnia, appetite loss, and stomach pains. When discontinued, patients may also experience withdrawal symptoms, including headache, irritability, nausea, and abnormal chewing movements and movements of the tongue. Other stimulants used for ADHD (usually when methylphenidate has not been effective or produced too many negative side effects) include dextroamphetamine (Dexedrine, Zenzed), mixed amphetamine salts (Adderall) and dextromethamphetamine (Desoxyn). Most of these drugs are available in controlled-release formulations so that only once or twice daily administration is possible for treating children going to school.
Ampakines are a newer class of drugs that enhance attention span and alertness and improve memory. While these drugs increase alertness, they do not produce the effects on the body that amphetamines do since they do not act directly on the dopaminergic activity of the brain. Ampakines are being investigated for their effects on sleep and sleep deprivation but are not yet available in an FDA-approved form. Eugeroics are another class of stimulant that improves wakefulness and alertness and reduces tiredness and the need for sleep. They work by activating specific nerve cells in the hypothalamus rather than stimulating the entire nervous system. As such, these drugs are non-addictive and are targeted to treating fatigue, lethargy, and narcolepsy, as well as enhancing motivation and productivity.
Caffeine and nicotine
Caffeine and nicotine are classified as secondary stimulants because, unlike drugs such as amphetamines and cocaine, they affect the sympathetic nervous system more than the central nervous system. Also unlike stimulants that are abused for recreational purposes, caffeine and nicotine produce only an increased energy level but not a feeling of intoxication or delusional thoughts or behavior. Caffeine is the most commonly used stimulant and most widely consumed drug in the United States, and is found in coffee, tea, soft drinks, energy drinks, chocolate, and drugs. Caffeine may also be an ingredient in pain relievers, diet pills, and cold and allergy medications.
Caffeine belongs to a family of drugs called methylxanthines, and it works by disrupting the action of a neurotransmitter called adenosine. Since caffeine is usually consumed in food, it normally enters the body through the gastrointestinal system, passing from the intestines into circulating blood, which carries it throughout the body. It reaches its maximum Page 1147 | Top of Articleeffect within 30-60 seconds from the time it is consumed, and remains in the body for several hours. Caffeine is addictive. Individuals who consume it regularly develop a tolerance for it and need progressively greater amounts to continue getting the same effect. For this reason, diet pills containing caffeine lose their effectiveness after a few days when tolerance is established. Caffeine consumption results in physical dependence and stopping its use may produce withdrawal symptoms such as headache, anxiety, and fatigue. Psychological dependence may also be noted in the form of craving. Daily caffeine consumption equal to the amount contained in one cup of coffee or soft drink (under 240 milligrams) is generally believed to be harmless, but consumption over 600 milligrams (the amount in four cups of coffee) may cause anxiety, sleep and digestive disorders, rapid heartbeat, and other health problems.
Another widely ingested stimulant is the nicotine consumed in tobacco products.Nicotine acts mostly as a stimulant in new users, but long-term users claim that it relaxes them. Although use of tobacco by middle school and high school students rose steadily during the 1990s, cigarette smoking has declined while use of other tobacco products such as electronic cigarettes, smokeless tobacco, and hookah use has increased. The Centers for Disease Control and Prevention report that approximately 9.2% of teenagers reported smoking cigarettes in 2014, a decrease from 15.8% in 2011. The use of hookahs has increased in the same time period from 4.1% to 9.4%. The use of multiple tobacco products by teenagers is reported to increase the risk for nicotine dependence and is predictive of use in adulthood.Nicotine withdrawal symptoms include anxiety, irritability, insomnia, depression, headaches, mood swings, difficulty concentrating, and changes in appetite.
Abuse of illegal stimulants
Drugs that stimulate the central nervous system are often used recreationally and addiction is common. Abuse may lead to medical, psychiatric and psychosocial disorders, mainly because using these drugs will reduce production of natural body chemicals that perform vital functions. The primary illicit drugs used as stimulants recreationally are amphetamines and cocaine. Street names for various types of amphetamines include speed, uppers, dexies, ben-nies, ice, L.A. ecstasy, and crank. Amphetamines produce an effect similar to that of the hormone adrenaline, making its users feel awake, alert, and energetic. The stimulating effects of cocaine are similar. In the 1950s and 1960s amphetamines were widely used by people who needed to keep themselves awake through the night, including truck drivers and night musicians, or by athletes for extra energy. Many young people used them to stay awake while cramming for exams or studying. Up to half of the amphetamines sold by drug companies in the 1960s were sold illegally. After the government imposed controls on the manufacture of these drugs, they began to be produced illegally in home laboratories. Not only are these preparations vulnerable to contamination, they are often diluted by manufacturers and dealers. Many drugs sold on the street as amphetamines contain mostly caffeine and other drugs, with only a small percentage of amphetamine and sometimes none at all.
The use of amphetamines declined in the 1980s as cocaine became the drug of choice. However, in the 1990s methamphetamine (speed) has became popular, especially among middle-class suburban teenagers. It is available in a crystalline form (i.e., ice, L.A. ice, or crank) that can either be smoked or snorted like cocaine. Users like it because it reaches the brain almost immediately, and its effects last longer than those of cocaine. It produces feelings of alertness, euphoria, and increased energy. Like other amphetamines, crank also decreases appetite and promotes weight loss, making it attractive to young women, who represent a large percentage of users.
People taking methamphetamine, which remains in the body for as long as four days, quickly establish a tolerance for the drug and require ever greater amounts to experience the same effect. Users can Page 1148 | Top of Articlebecome addicted very quickly. Its side effects include dry mouth, sweating, diarrhea, insomnia, anxiety, and blurred vision. Severe reactions may include hallucinations (called “tweaking” ), paranoia, and speech disorders, all of which may persist for up to two days after use. Psychological dependency on the euphoric effects produced by these drugs can be life threatening, since usage is sometimes followed by a “crash” that produces severe depression and suicidal tendencies.
“Ecstacy,” also known as MDMA, is a popular drug derived from methamphetamine. It combines the characteristics of a stimulant and a psychedelic drug, producing hallucinations and enhanced feelings of sociability and closeness to others. It is less addictive than amphetamines but potentially more dangerous. Young people have died from taking this drug; some had preexisting heart conditions, but others had no known medical problems. MDMA may cause brain damage, and its use has been reported to lead to development of panic disorder.
Cocaine is a stimulant made from the leaves of the coca plant. Its street names include coke, snow, toot, blow, stardust, nose candy, and flake. When the pure drug was first extracted from the leaves in the 19th century, its harmful effects, including its addictive potential, weren't known. As a result, in the early 20th century, it was legally sold in medicines and soft drinks, including Coca-Cola, which originally contained small amounts of the substance (from which its name is derived).Cocaine use has been illegal since 1914. At first cocaine was largely used in a diluted powder form that was inhaled. In the 1980s and 90s, more potent smokable forms were developed, first “freebase” then “crack.” Cocaine also became visible as a substance abused by celebrities, including actor John Belushi (who died of a cocaine-heroin overdose), comedian Richard Pryor (who was badly burned freebasing cocaine), and Washington, D.C. mayor Marion Barry, who was forced to resign from office.
Cocaine produces a physical addiction by affecting the brain's chemistry and a psychological addiction as users become dependent on the confident, euphoric feeling it creates to help them cope with the stresses of daily life. Possible negative reactions to large doses of cocaine use include hallucinations, paranoia, aggressive behavior, and even psychotic “breaks” with reality. Cocaine may result in irregular heart beat, seizures, strokes, and comas. Reactions to withdrawal from the drug are so severe that most users are unable to quit without professional help. Withdrawal symptoms may last for weeks, including muscle pains and spasms, shaking, fatigue, and reduced mental function. Inpatient and outpatient rehabilitation programs are available to treat cocaine addiction.
Labbate, Lawrence A., Maurizio Fava, Jerrold F. Rosenbaum, George W. Arana. The Handbook of Psychiatric Drug Therapy. Philadelphia, PA:Lippincott Williams & Willkins, 2014
Boyle, J., Stanley, N., James, L.M., et al.“Acute sleep deprivation: Theeffects of the Ampakine compound CX717 on human cognitive performance, alertness and recovery sleep.” Journal of Psychopharmacology (Oxford, UK) 26 (Aug 2012): 1047–1057.
Broadley, K.J.“The vascular effects of trace amines and emphetamines.” Pharmacology & Therapeutics 125 (Mar 2010): 363–375.
Ciccarone, Daniel.“Stimulant Abuse: Pharmacology, Cocaine, Methamphetamine, Treatment, attemps at Pharmacotherapy.” Primary Care. 38 (Mar 2011): 41–58.
Dell'Osso, B., Ketter, T.A., Cremaschi, L., et al.“Assessing the role of stimulants/stimulant-like drugs and dopamine-agonists in the treatment of bipolar depression.” Current Psychiatry Repots. 15 (Jan 2013): 378–383.
Eiden, L.E., Weihe, E.“VMAT2: a dynamic rgulator of brain monoaminergic neuronal function interacting with drugs of abuse.” Annals of the New York Academy of Science. 1216 (Jan 2011): 86–98.
Substance Abuse and Mental Health Services Administration (SAMHSA) Prescription Drug Misuse and Abuse. updated Sept 2014. (accessed Sept 8, 2015). http://www.samhsa.gov/prescription-drug-misuse-abuse .
American society for Clinical Pharmacology and Therapeutics, 528N Washington Street, Alexandria, VA, 22314, (703) 836–6981
National Cocaine Hotline, (800) COCAINE
Drug Abuse Clearinghouse, P.O. Box 2345, Rockville, MD, 20847–2345, (301) 443–6500, (800) 729–6686
National Cocaine Hotline, (800) COCAINE