Like sterioids for the brain, amphetamines can make people better at whatever they do, until the effects wear off. Are the benefits worth the side-effects?
Amphetamines in FOCUS:
Brain-Performance, Stay-Awake and Anorectic (Lose-Desire-to-Eat) Drugs
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 can make people 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.
What are Amphetamines?
All the following are collectively called “amphetamines”:
All amphetamines (amphetamine, dextroamphetamine and methamphetamine) have essentially the same chemical properties and their actions are so alike that even experienced users may not feel a difference between them, according to a 2005 report by the Drug Enforcement Agency (DEA).
Using amphetamines once is sufficient to induce some of these symptoms:
- Enhanced mood and body movement
- Increased wakefulness, physical activity
- Increased respiration
- Increased heart rate
- Increased blood pressure
- Reduced appetite
- Cardiovascular collapse, death
- Dilated pupils
- Damage to brain cells containing serotonin
- Over time, reduced level of dopamine resulting in Parkinson's-like symptoms
- Weight loss
- Damage to nerve cells, causing strokes
- Cardiovascular collapse, death
Effects from Withdrawal:
- Fatigue and long periods of sleep
Behaviors resulting from amphetamine intoxication such as withdrawal from others, experiencing hallucinations, paranoia, delirium perhaps occurring with violence and stereotyped behaviors such as repeatedly assembling and dissembling electronic equipment may resemble symptoms of schizophrenia. But a skilled clinician should be able to make the proper diagnosis.
History of Amphetamines
First marketed as Benzedrine in an asthma inhaler, amphetamines became very popular as “uppers” and diet pills by the mid-1900s. Military commanders, truck drivers and students turned to amphetamines for similar reasons: They can keep you fighting long after your body would otherwise surrender to sleep.
As use of amphetamines spread, so did their abuse. In 1965, federal drug laws were initiated to curb the black market in amphetamines and now all amphetamines are considered potential drugs for abuse under the Controlled Substances Act. Production levels in the United States are regulated by the DEA, which sets quotas (or limits) on the amount that may be manufactured each year, in an effort to control illegal uses.
How Amphetamines Work
When we are stressed or under threat, the central nervous system prepares us for physical action by creating particular physiological changes. Amphetamines prompt the brain to initiate this 'fight or flight' response. These changes include:
- The release of adrenalin and other stress hormones
- Increased heart rate and blood pressure
- Redirected blood flow into the muscles and away from the gut
In small doses amphetamines can banish tiredness and make the user feel alert and refreshed. However, this drug-induced burst of energy and focus comes at a price: a “speed crash” always follows the high and may leave the person feeling nauseous, irritable, depressed and extremely exhausted.
- Attention deficit disorder
Common Side Effects
- Loss of appetite
Less Common Side Effects
- High blood pressure
- Rapid pulse rate
- Tolerance (continued need to raise the dose)
- Feelings of suspicion and paranoia
FDA Warning: Links Between ADHD Drugs and Priapism and Sexual Dysfunction
In a recent drug-safety announcement, the FDA announced that drugs containing methylphenidate must including warnings about the risk of priapism. (Methylphenidate drugs include: Concerta, Daytrana, Focalin, Metadate, Methylin, Quillivant, and Ritalin.) 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 FDA included an even stronger warning about atomoxetine (Strattera): “Priapism appears to be more common in patients taking atomoxetine than in patients taking methylphenidate products. Health care professionals should be cautious when considering changing patients from methylphenidate to atomoxetine.”
The safety warning also raised concerns about links between priapism and amphetamine drugs, which include Adderall, Dexedrine, ProCentra and Vyvanse.
Required “Black Box” Warning Label
The Food and Drug Administration (FDA) requires the following “black box” warning on all amphetamines, which means that medical studies indicate the drugs carry a significant risk of serious, or even life-threatening, adverse effects.
AMPHETAMINES HAVE A HIGH POTENTIAL FOR ABUSE. ADMINISTRATION OF AMPHETAMINES FOR PROLONGED PERIODS OF TIME MAY LEAD TO DRUG DEPENDENCE AND MUST BE AVOIDED. PARTICULAR ATTENTION SHOULD BE PAID TO THE POSSIBILITY OF SUBJECTS OBTAINING AMPHETAMINES FOR NONTHERAPEUTIC USE OR DISTRIBUTION TO OTHERS, AND THE DRUGS SHOULD BE PRESCRIBED OR DISPENSED SPARINGLY.
MISUSE OF AMPHETAMINE MAY CAUSE SUDDEN DEATH AND SERIOUS CARDIOVASCULAR ADVERSE EVENTS.
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 amphetamine drugs can cause extreme fatigue and severe, even suicidal, depression in adult patients.
If It Does Work
"In the treatment of ADHD for children and young adults, [amphetamine] 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. "[Amphetamine] 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."
What are the Risks?
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.
Induction of schizophrenic-like states in children on prescribed doses of stimulant medications, including Adderall, 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 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 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 Sexual Dysfunction
Referring again to 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."
ABOVE: Pus-streaked gums with blackened and rotting and broken teeth are attributed to heavy methamphetamine use. Despite its street name “meth mouth,” similarly accelerated tooth disease can be caused by the abuse of other stimulants with similar actions, such as amphetamines, cocaine and methylphenidate. NEWSWEEK, Aug. 8, 2005: www.slate.com/~.
Abuse of amphetamines has many serious potential side effects, including psychotic behavior, depression, anxiety, fatigue, paranoia, aggression, violent behavior, confusion, insomnia, auditory hallucinations, mood disturbances and delusions.
Violent and erratic behavior is frequently seen among chronic abusers of amphetamines, especially methamphetamine.
According to the DEA the effects of amphetamines are similar to cocaine but the onset is slower and the duration is longer. Chronic abuse produces a psychosis that resembles schizophrenia and is characterized by paranoia, picking at the skin, preoccupation with one’s own thoughts, and auditory and visual hallucinations. These psychotic symptoms can persist for months and even years after use of these drugs has ceased, and may be related to their neurotoxic effects.
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