Stimulants

What Are Stimulants?

Stimulants are drugs that speed up your central nervous system. They lead to effects like increased alertness and focus. They may also cause physical changes, like increased heart rate and a loss of appetite.

There are many forms of stimulants. Some come from nature, while others are human-made. Caffeine is the most-used stimulant in the world.

In general, these drugs fall into two main groups based on their intended use: medical (therapeutic) and nonmedical (recreational drugs or “uppers”). Because of the way stimulants make you feel, many carry a risk of misuse and dependence or addiction. You’ll see your healthcare provider regularly if you take a prescription stimulant.

What do stimulants treat?

There are several types of therapeutic stimulants. Each kind treats specific conditions. In general, they have approval from the U.S. Food and Drug Administration (FDA) to treat:

• Attention-deficit/hyperactivity disorder (ADHD)
• Apnea in preterm infants
• Narcolepsy
• Nasal and sinus congestion
• Shift work sleep disorder
• Obesity
• Binge eating disorder
• Apathy in neurological disorders

Types

Most stimulants fit into one of two categories: medical or nonmedical. But some overlap depending on the specific formulation and dose.

One example is caffeine. Most caffeine uses are recreational or nonmedical, like having a cup of coffee or tea. But it also has medical purposes in certain cases. For example, caffeine can help treat breathing issues (apnea) in preterm infants. It’s also combined with certain medicines, like headache medicines.

Stimulant medications

Medical (therapeutic) forms may be prescription or behind-the-counter medications. Some examples of prescription stimulants include:

• Amphetamine (Evekeo® and Adzenys®)
• Dextroamphetamine (Dexedrine® and Xelstrym®)
• Amphetamine combination medicines (Adderall®, Dyanavel® and Mydayis®)
• Dexmethylphenidate (Focalin®)
• Methylphenidate (Concerta®, Daytrana®, Methylin™ and Ritalin®)
• Modafinil (Provigil®)

In the U.S., the Drug Enforcement Administration (DEA) classifies most prescription stimulants as Schedule II drugs. This means they’re associated with serious risks, including misuse, addiction and overdose. Because of this, you should take them exactly as prescribed. When taken this way, the risk of addiction is lower. Misuse can lead to substance use disorder.

Behind-the-counter stimulants include ephedrine and pseudoephedrine. They’re nasal and sinus decongestants. They work by narrowing blood vessels and reducing swelling in your nose to improve airflow.

“Behind the counter” means you don’t need a prescription for them. But you must ask a pharmacy employee for assistance to buy them, as required by law. You may also have to be a certain age to buy them.

Nonmedical stimulants

People mainly use the following stimulants for nonmedical reasons. But some of them have approved or experimental therapeutic uses. Nonmedical stimulants include:

• Cocaine, also known as coke or crack (medical cocaine has very rare uses, mainly for numbing and reducing bleeding)
• Nicotine (used therapeutically in nicotine replacement therapy for smoking cessation)
• Khat (illegal in the U.S., but legal and considered therapeutic in some countries)
• MDMA, also known as ecstasy or molly (researchers are exploring its potential use for post-traumatic stress disorder treatment)
• Methamphetamine, also known as meth or crystal meth

These drugs have high potential for addiction.

How do stimulants work?

Stimulants speed up the messaging between your brain and body. They do this by triggering your brain to release more chemicals (neurotransmitters), especially dopamine and norepinephrine.

Dopamine plays a role in many functions, like behavior, attention and wakefulness. It’s also a key part of your brain’s reward system. That’s why stimulants have potential for addiction. They may cause a “high” or euphoric feeling.

Stimulants can make you feel:

• Alert or awake
• Attentive or focused
• Energetic or motivated
• Less hungry
• Upbeat or positive

Dopamine and norepinephrine are also part of your “fight-or-flight” stress response. That’s why stimulants increase your heart rate, blood pressure and breathing.

Side effects

Stimulants can cause a range of short-term and long-term side effects. Your likelihood of experiencing these effects depends on many factors. Some include the type of stimulant and its dose and your body weight and tolerance.

Common side effects of stimulants include:

• Dizziness
• Fast heart rate and high blood pressure
• Feeling anxious, restless or irritable
• Headache
• High body temperature
• Loss of appetite (which may cause unintended weight loss)
• Reduced blood flow to your hands and feet
• Shakiness (tremor)
• Stomachache
• Trouble sleeping (insomnia)

Less common, but serious, side effects include heart problems and seizures.

Each person is different. Your healthcare provider or pharmacist can tell you more about possible side effects. They can also tell you which ones need care right away and which can wait for an appointment.

Risks and complications

Most stimulants have dependence and/or addiction potential. Dependence happens when your body adapts to the stimulant. You then have withdrawal symptoms when you stop taking it. Addiction is more severe. It means you compulsively seek out and take a substance despite negative or harmful consequences.

Addiction involves substance misuse, which means using more than the prescribed dose of medical stimulants or using nonmedical stimulants. Misuse can lead to complications like:

• Chronic insomnia
• Compulsive skin-picking (dermatillomania)
• Tooth-grinding (bruxism)
• Psychosis (paranoia or hallucinations)
• Confusion
• Heart palpitations and abnormal rhythms
• Heart attack
• Stroke
• Overdose and death

If you think you have stimulant dependence, see a healthcare provider right away. The sooner you get help, the more likely you’ll be able to prevent serious health risks. You can also reach out to a free, confidential National Helpline (SAMHSA at 1.800.662.HELP) when you’re ready.