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Stimulants

EDPS 674
Alison Lessard, Christina Majcher, Nicole Dickson

Introduction

History of stimulant medication

Characteristics of stimulants

Application of stimulant medication

Applications for learning

Negative effects and interaction effects

Drug abuse and withdrawal effects

Controversies

History of Stimulant Medication

Stimulants were first discovered in late 1800s


1929 amphetamine developed by Gordon Alles
Psychological benefits were apparent - increased energy, positive mood, enhanced
mental alertness and cognition
1920s Benzedrine inhaler introduced as a treatment for asthma
1937 Benzedrine was approved to treat narcolepsy, Parkinsons, depression, and obesity
Discovered that stimulants had a calming effect on hyperactive children

History of Stimulant Medication

During WWII used in huge quantities by both sides


Prescribed to fighter pilots help them stay alert and able to stay awake for long periods
or high doses created higher levels of aggression
Prized by Generals - believed stimulants increased morale and made soldiers more
aggressive
1966-1969 in Vietnam massive amounts of pills distributed to troops

History of Stimulant Medication


1960s huge increase in prescribed and recreational use of
stimulants
Concerns- addictive properties of stimulants as well as
amphetamine-induced psychosis

1970s US government criminalizes sale without prescription

Ritalin (methylphenidate) popular for treating hyperactivity

Black Market - ecstasy, methamphetamine

White Market - Ritalin, Concerta, Dexedrine

Characteristics of Stimulants

Disrupt or modify the normal communication among brain neurons and circuitry
Overstimulates the receptors either by increasing the neurotransmitter called dopamine
or inhibiting its reuptake or breakdown
Result is increased levels of dopamine which increases the transmission of signals
between neurons
Affects the attention systems of the brain and activates the sympathetic nervous system,
producing increased heart rate and blood pressure
Higher the level of dopamine the greater the feelings of euphoria and satisfaction

Application of Stimulant Medication


Application for Adults and Children with ADHD
Common Uses:
Dopamine levels are low in people with ADHD
Stimulants increase level of dopamine

Research:
Stimulant medications are effective in treating ADHD; in long-term they are equally as
effective as behavioural therapy
Long-term study of a group of adults treated with stimulant medication during childhood and
adolescence found stimulant medication is effective treatment for ADHD

Application of Stimulant Medication


Application for Adults and Children with other conditions
Narcolepsy- help reduce daytime sleepiness
Depression- at times a stimulant is added to an antidepressant if an individual is only
partially responding to antidepressant therapy
Brain damage that is affecting attention and organizational problems
Severe medical illnesses with apathy or lethargy

Application of Stimulant Medication

Applications for Learning

Stimulant medication helps improve cognition, mood and attention-related tasks


o

focus better

ignore distraction

regulate their own behaviour and thinking

help with emotional regulation

Negative Effects
Negative side effects include:
Decreased appetite
Mild insomnia
Stomach-aches
Headaches
Nausea and dizziness
Temporary growth suppression and weight loss
Irritability and or sadness
Motor and/or vocal tics
Increased blood pressure, heart rate, and body temperature
Allergic reactions (e.g., skin rashes)
Obsessive-compulsive ruminations
Stimulant induced psychosis
Psychological dependence, drug abuse, and addiction
Irreversible damage to blood vessels and sudden death
Overdosage

Negative Effects
According to the FDAs
Adverse Event
Reporting System
(MedWatch), there have
been 17,021 adverse
drug reactions reported
between 2004 and 2012
in connection with
stimulant use.

(Retrieved from: http://www.cchrint.org/psychiatric-drugs/stimulantsideeffects/)

Negative Effects
Individuals with the following conditions should not take stimulants:
Significant anxiety, agitation, and/or nervousness
Motor tics or a family history of Tourette's disorder
Individuals who are currently experiencing or have a history of psychosis
Glaucoma (a disorder that causes increased pressure in the eyes)
Hyperthyroidism
Existing liver disorder or abnormal liver function test results
Individuals with known structural cardiac abnormalities, cardiomyopathy, heart
rhythm abnormalities, or other serious cardiac problems
History of drug abuse or addiction

Interaction Effects
Individuals who have taken an MAO inhibitor in the past 14
days should not be prescribed stimulant medication. MAO
inhibitors include isocarboxazid, linezolid, phenelzine,
rasagiline, selegiline, and tranylcypromine
There are no significant interaction effects between stimulants
and other antidepressants or drugs that are commonly
prescribed to youth
Stimulant medication can intensify the effects of alcohol, as
well as illicit drugs such as marijuana and cocaine

Drug Abuse and Withdrawal Effects

Concerns about the abuse potential of stimulants has been increasing given that:
o Children with ADHD are at increased risk for drug use and abuse during
adolescence
o Children and adolescents are being treated in increasing numbers with stimulants
o Stimulant use may serve as a gateway to other illicit drugs
Family members and other individuals may abuse a childs stimulant medication
Stimulant medications are classified as drugs of abuse by the Drug Enforcement
Administration
When stimulants are discontinued, the body must begin producing the neurotransmitters
that were previously used up by stimulant abuse. The time this takes is dependent on the
dosage and length of time that an individual used stimulants
Withdrawal effects, particularly on abrupt discontinuation of stimulant medication after
prolonged use, can last up to two weeks

Withdrawal Symptoms
Symptoms of withdrawal from stimulants can include:
Sleep disturbance (e.g., insomnia and hypersomnia)
Fatigue and lack of energy
Nervousness, anxiety, and irritability
Depression and suicidal thoughts
Intense hunger
Craving for the drug
Withdrawal of a stimulant drug after long-term use should be
gradual and closely monitored to avoid the risk of withdrawal
symptoms. Withdrawal symptoms are rarely life threatening.

Controversies with Stimulants

Whether stimulant medication is being overprescribed

What predicts an individuals response to stimulants and/or side effects

Stimulant medication is often being prescribed by family doctors with little


training rather than psychiatrists

The use of stimulants for long-term treatment

Whether stimulants should be used with preschoolers

Whether the use of stimulant medication to treat children with ADHD increases
the risk of substance abuse in adulthood

References
Greenhill, L.L., Pliszka, S., & Dulcan, M.K. (2002). Practice parameter for the use of stimulant
medications in the treatment of children, adolescents, and adults. Journal of American Academy of
Child and Adolescent Psychiatry, 41(2), 26-49. doi:10.1097/00004583-200202001-00003
Mash, E.J., & Barkley, R.A. (2006). Treatment of Childhood Disorders, 3 rd edition. The Guilford Press.
New York: London
Rasmussen, N. (2008). On speed: The many lives of amphetamine. New York: New York University
Press.
Santosh, P.J. & Taylor, E. (2000). Stimulant drugs. European Child & Adolescent Psychiatry, 9(1),
127-143. doi:10.1007/s007870070017

References
Spiller, H.A., Hays, H.L., and Aleguas, A. (2013). Overdoseof drugs
for attention-deficit hyperactivity disorder: Clinical presentation,mechanisms of toxicity, and managem
en
t. CNS Drugs, 27(7), 531-543. doi:10.1007/s40263-013-0084-8
Smith, M. E., & Farah, M. J. (2011). Are Prescription Stimulants Smart Pills?: The Epidemiology and
Cognitive Neuroscience of Prescription Stimulant Use by Normal Healthy Individuals. Psychological
Bulletin, 137(5), 717741. doi:10.1037/a0023825
Zheng, C., Lichenstein, P., Halldner, L., DOnofrio, B., Serlachius, E., Fazel, S., et al. (2014).
Stimulant ADHD medication and risk for substance abuse. Journal of Child Psychology and
Psychiatry, 55(8), 878-885. doi:10.1111/jcpp.12164