The Amphetamine Debate

By:

ELAINE MOORE

Rating:

Personal Thoughts

This book covers both sides of Adderall prescription and use. It discusses the history of amphetamine and related stimulants; ADHD and the use of Ritalin and Adderall to treat it; related neuroenhancers; methamphetamine from Desoxyn to crystal meth; the nature of addiction and side effects; sociological effects of amphetamine compounds; and expert opinions for and against Adderall use

Summary Notes

Somewhat large doses of amphetamine (20-50 mg of D-amphetamine daily or more than 30 mg of mixed amphetamine salts) intensify amphetamine’s effects. As a result, at higher doses the relaxed alertness induced by low doses of amphetamine is usually replaced by a driven feeling. At higher than recommended doses, thoughts scatter through the mind quickly, increased talkativeness exhausts and bores one’s listeners, and the ability to concentrate is diminished (Iversen 2008, 14).
In conditions such as ADHD where dopamine levels are typically low, amphetamines used at low doses have a calming rather than stimulating effect, presumably because the drug helps to restore diminished dopamine levels.
All of the sympathomimetic amines stimulate the sympathetic nervous system, causing effects similar to those caused by a rush of adrenaline. Like most family members, the individual sympathomimetic amines differ slightly from one another in their characteristics. These differences include variations in the potency and specific organ and nervous system effects. For instance, methamphetamine stimulates the nervous system to a greater degree than amphetamine.
Overall, amphetamine influences cerebral circuits in the prefrontal cortex, basal ganglia and cerebellum. These brain components are associated with motivation, reward, executive functioning and motor coordination. With increased levels of dopamine and norepinephrine, amphetamine fine-tunes an individual’s ability to focus and pay attention.
The ability of amphetamine to raise dopamine levels is responsible for the majority of its desirable effects. Dopamine is a central neurotransmitter with particular importance in the regulation of movement and with reward mechanisms in the brain. Dopamine increases feelings of well-being. Low dopamine levels are associated with social anxiety, difficulties with focus and concentration, depression, and a variety of conditions related to a depressive form of low energy called anergia.
Amphetamines have long been used as weight loss agents, although the wisdom of this use is controversial because weight loss is seldom sustained after the drug is stopped. Weight loss caused by amphetamines is almost entirely a result of reduced food intake and only partially due to an increased metabolism. There may be other reasons for weight loss related to increased dopamine and norepinephrine levels, but the mechanisms supporting this are unclear.
Most of the amphetamine-related deaths that have been reported are due to excessive stimulation of heart and a quick rise in blood pressure, leading to stroke (cerebral hemorrhage) or heart failure. Fatal overdoses usually progress to convulsions and coma. Stroke in these cases is primarily related to damage and bleeding in the blood vessels of the brain. Damage to the blood vessels of the brain is the most common pathological finding on autopsy (Iversen 2008, 13). Amphetamines can raise the body temperature, and hyperthermia is suspected of contributing to the deaths in several athletes using moderate doses of amphetamines in the 1960s and 1970s. The majority of cases of cardiovascular collapse secondary to ventricular fibrillation have occurred in individuals less than 30 years old with no evidence of pre-existing heart disease (Ellinwood 2000, 3). Other miscellaneous causes of amphetamine-related deaths include septicemia with bacterial endocarditis or necrotizing angiitis occurring primarily in intravenous drug users.
Symptoms that can result from a therapeutic amphetamine drug dose include increased confidence; increased energy; reduction in fatigue; improved focus and concentration; improved mood; sense of well-being; palpitations; headache; dry mouth; diminished appetite; tremor; increased heart rate; increased blood pressure; increased body temperature, increased sweating, impaired sleep; decreased tendency toward sleepiness; increased tactile, visual, olfactory and auditory perceptions; changes in sex drive; increased sociability; and euphoria (Grinspoon and Hedblom 1975, 62-5; Iversen 2008, 12-14).
In any given year, about 20 million Americans use amphetamines (Rasmussen 2008a, 244). Many people have used low doses of amphetamine for extended periods for medical conditions, such as narcolepsy or depression, with no untoward effects and without any compulsion to take higher doses. As the pharmacology expert Everett Ellinwood points out, in the 1960s when amphetamines were used freely for weight loss, only a small percentage of users developed problems with amphetamine abuse (Ellinwood 2000). Ayn Rand was treated for a condition of fatigue with therapeutic doses of amphetamines for more than 30 years. When she changed physicians and was told to stop taking amphetamines, she stopped taking them without developing problems (Branden 1986, 173).
In an animal study from Newfoundland, Canada, Dr. Bow Lett found that repeated exposures to amphetamine, morphine, and cocaine intensify rather than diminish the rewarding effects. In other words, Lett found that extended use of the drug at low doses intensifies the rewarding or pleasurable effects. Consequently, higher doses aren’t needed to get the same euphoric effects. These subjects were apparently sensitized to their drugs of choice instead of developing tolerance to them (Lett 1989).
Heightened impulsivity is a risk factor for drug abuse. Individuals with high impulsivity may be more likely to experiment with drugs, more likely to continue using drug’s after initial exposure, and have more difficulty abstaining once they’ve used drugs on a regular basis (deWit and Richards 2001). Studies in ADHD show that children with impulsivity show more rapid discounting of the value of delayed consequences. The serotonin system is thought to be critically involved in the ability to inhibit or stop impulsive responses, whereas the dopamine system is involved in the valuation of delayed consequences. The direct experience of rewards and delays also affects impulsivity and is considered in behavioral therapies for ADHD.
The pathology or causes of disease development in ADHD are unclear. The effective use of psychostimulant medications and noradrenergic tricyclic antidepressants in ADHD suggests that certain brain areas related to attention are deficient in neural transmission, particularly in regards to dopamine and norepinephrine in the frontal and prefrontal regions of the brain. The parietal lobe and cerebellum may also be involved, and right prefrontal neurochemical changes in adolescents with ADHD have also been found.
Stimulant drugs increase movement and motivation. These processes depend upon increases in dopamine transmission within the brain’s limbic system. Neurochemical actions within the frontal cortex may also contribute to the ability to modulate some of these basic motivational processes (Taylor and Jentsch 2001, 123). PET scan imaging studies indicate that methylphenidate and amphetamines act to increase dopamine (Soreff 2010). Stimulants also cause increased norepinephrine levels. However, the effect of norepinephrine on alterations in cognitive function in ADHD is unknown, although benefits of norepinephrine are presumed to be related to its arousal-enhancing actions (Berridge, 2001, 177).
Somewhat large doses of amphetamine (20-50 mg of D-amphetamine daily or more than 30 mg of mixed amphetamine salts) intensify amphetamine’s effects. As a result, at higher doses the relaxed alertness induced by low doses of amphetamine is usually replaced by a driven feeling. At higher than recommended doses, thoughts scatter through the mind quickly, increased talkativeness exhausts and bores one’s listeners, and the ability to concentrate is diminished (Iversen 2008, 14).