Drug Enquirer


dictionary illustration of phrenology brain
Amphetamine side effects include neurotoxicity and addiction.

Amphetamines in FOCUS

The Devil is in the Side Effects

Are short-term benefits worth long-term effects?

These powerful stimulants do more than increase alertness, concentration and mental productivity, amphetamines decrease fatigue and produce a short-term mood elevation, even in those who are not depressed. Like steroids for the brain, amphetamines appear to make people feel like they perform better at whatever they do—until the effects wear off. The next day without the drug, amphetamine users often complain that they feel tired, “stupid,” or depressed.

The real trouble begins when the user doesn't stop taking the drug.

Eroding the Mind. Amphetamines, Neurotoxicity and Brain Decay. Areas of greatest damage: Basal ganglia is in the deepest inner region of the brain and acts as a major switching station for thinking ability, problem solving, task flexibility, motor function and emotion. Frontal white matter provides communication pathways for cognitive speed and cognitive function.

Amphetamine Brain Damage

Amphetamines cause damage to neurons—brain cells needed for thinking.

A clinical study funded by the National Institutes of Health compared persons who had previously used methamphetamine with non-users. The former drug users were found to have significantly lower levels of N-acetylasparatate (a neuronal marker indicating neurotoxicity and damage) in two key areas of their brains, the basal ganglia and frontal white matter.

The lead scientist, Dr. Thomas Ernst, stated: “Many brain diseases associated with brain cell or neuronal damage or loss, such as Alzheimer's disease and other dementia, epilepsy, multiple sclerosis, brain tumors, stroke and HIV brain diseases, consistently have shown decreased N-acetylaspartate. This, in the drug users' brains, suggests neuronal loss or damage as a result of long-term methamphetamine use.”

Researchers found amphetamine users have the same neuronal damage as found in dementia and Alzheimer's disease.

The areas of greatest damage are responsible for communication within the brain. Basal ganglia is in the deepest inner region of the brain and acts as a major switching station for thinking ability, problem solving, task flexibility, motor function and emotion. Frontal white matter provides communication pathways for cognitive speed and cognitive function.

Ernst T, et al. Evidence for long-term neurotoxicity associated with methamphetamine abuse A 1H MRS study. Neurology 2000;54(6):1344-1349.

What are Amphetamines?

All the following are collectively called “amphetamines”:

Drug Enforcement Administration, Department Of Justice: Schedule II Controlled Substance
Amphetamines are DEA Schedule II Controlled Substances (The federal government sets limits on the amount that may be manufactured each year.)

How Do Amphetamines Work?

Amphetamines work by by initiating the acute stress response (“fight or flight” response). The central nervous system prepares the body for physical action by creating physiological changes as if it were stressed or under threat. These changes include:

Small doses of amphetamines can banish tiredness and make the user feel alert and refreshed. However, the burst of energy comes at a price. A “speed crash” always follows the high and typically leaves the user feeling nauseous, irritable, depressed and extremely exhausted.

“The effects of amphetamines and methamphetamine are similar to cocaine, but their onset is slower and their duration is longer.”

ABOVE:Drug Enforcement Administration (DEA), US Department of Justice (DOJ). “Drug Fact Sheet: Amphetamines,” undated, retrieved 1/5/2013: www.justice.gov/dea/druginfo/drug_data_sheets/Amphetamines.pdf

Do Not Use If

You have not tried other psychotherapy, have high blood pressure or any form of heart disease, are very nervous or have severe insomnia, have a history of addiction to drugs or alcohol, or have Tourette syndrome. Do not combine with monoamine oxidase inhibitors.

Common Side Effects

Less Common Side Effects

Overdose Side Effects

Amphetamines have been extensively abused. Extreme psychological dependence and severe social disability have resulted. Abuse of amphetamines may cause a sudden heart attack even in those with no signs of heart disease. Symptoms of overdose that require immediate medical assistance include:

Amphetamine-Induced Anxiety Disorder

The onset of amphetamine-induced anxiety disorder can occur during amphetamine use or withdrawal, according to best-selling psychiatry text, Kaplan and Sadock's Synopsis of Psychiatry citing the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

“Amphetamine, as with cocaine, can induce symptoms similar to those seen in obsessive disorder, panic disorder, and phobic disorders,” states Synopsis of Psychiatry.

Amphetamine-Induced Psychosis

Induction of schizophrenic-like states in children on prescribed doses of stimulant medications, including Adderall (amphetamines), have been observed, though not as well documented as with amphetamine abusers, according to The Journal of the American Board of Family Medicine in an article entitled, “Adderall-Induced Psychosis in an Adolescent.”

Amphetamine-Induced Sexual Dysfunction

The American Psychiatric Association’s Manual of Mental Disorders, Synopsis of Psychiatry states: “High doses and long-term use of amphetamines are associated with erectile disorder and other sexual dysfunctions.”

FDA: Links Between ADHD Drugs and Priapism and Sexual Dysfunction

In a 2013 drug-safety announcement, the FDA announced that drugs containing methylphenidate must including warnings about the risk of priapism. It's a serious problem. Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.

The safety warning also raised concerns about links between priapism and amphetamine drugs, which include Adderall.

ABOVE: U.S. FDA Drug Safety Communication, “FDA warns of rare risk of long-lasting erections in males taking methylphenidate ADHD medications and has approved label changes.” (12/17/2013).

Dependence, Tolerance and Withdrawal

It is possible to build up a tolerance to amphetamines, which means the person using the drug needs to take larger doses to achieve the same effect. Over time, the body might come to depend on amphetamines just to function normally. The person craves the drug and their psychological dependence makes them panic if access is denied, even temporarily.

Withdrawal symptoms can include tiredness, panic attacks, crankiness, extreme hunger, depression and nightmares. Some people experience a pattern of “binge crash” characterized by using continuously for several days without sleep, followed by a period of heavy sleeping.

If It Doesn't Work

The drug should be stopped gradually. Withdrawal symptoms are psychological and stopping suddenly can cause extreme fatigue and severe, even suicidal, depression in adult patients.

Abrupt cessation of Adderall and Adderall XR can cause extreme fatigue and severe, even suicidal, depression in adult patients.

ABOVE: The Essential Guide to Psychiatric Drugs—Rev. and updated (2007).

If It Does Work

“In the treatment of ADHD for children and young adults, Adderall XR is now prescribed frequently, often as a first-line drug. This is, in my opinion, a very serious mistake,” states Jack M. Gorman, M.D., professor of psychiatry at Columbia University and deputy director of the New York State Psychiatric Institute. “Adderall is now abused throughout college campuses, where it is bought, sold, stolen, borrowed, snorted and injected. It is a very powerful drug that undoubtedly works for ADHD, but there are alternatives with less abuse potential that should be tried first.”

Amphetamines produce gross reductions in blood flow to the brain.

Decreased blood flow to the brain plays a major role in cognitive impairment, dementia and Alzheimer's.

ABOVE: Breggin, PR. The Ritalin Fact Book; Perseus Books Group, 2002. Abreu BE, et al. Influence of amphetamine sulfate on cerebral metabolism and blood flow in man. J Pharm Sci, 1949;38:186–188. Lombard J, et al. The Brain Wellness Plan; Kensington Pub. Corp., 1998. Mazza M, et al. Primary cerebral blood flow deficiency and Alzheimer's disease: shadows and lights. Journal of Alzheimer's Disease 2011;23(3):375-89.

What are the differences between the various Amphetamines?

Adderall amphetamine plus dextroamphetamine
[instant release]
Adderall XR amphetamine plus dextroamphetamine
[extended release]
Benzedrine amphetamine
[instant release]
Biphetamine amphetamine plus dextroamphetamine
Desoxyn methamphetamine
[instant release]
Dexedrine dextroamphetamine
[instant release]
Dexedrine SR dextroamphetamine
[extended release]
Dexedrine Spansule dextroamphetamine
[extended release]
Dextrostat dextroamphetamine
[instant release]
ProCentra dextroamphetamine
[immediate release, bubblegum flavor]
Vyvanse dextroamphetamine
with lysine (lisdexamfetamine)
[extended release]
  • amphetamine = amfetamine = dl-amphetamine
  • dextroamphetamine = dexamfetamine
    = dexamphetamine = d-amphetamine
  • methamphetamine = d-methamphetamine

“All amphetamines have essentially the same chemical properties and their actions are so alike that even experienced users may not feel a difference between them.”

ABOVE: Drug Enforcement Administration (DEA), US Department of Justice (US DOJ). “Amphetamines,” Drugs of Abuse Publication. National Drug Intelligence Center, 2005 ed.