NEWS AND FACTS ABOUT MEDICINES YOU TAKE
“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
dictionary illustration of phrenology brain
Like steroids 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.

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.

What are Amphetamines?

All the following are collectively called “amphetamines”:

Using amphetamines once is sufficient to induce some of the following symptoms.

Short-Term Effects:

  • Enhanced mood and body movement
  • Increased wakefulness, physical activity
  • Increased respiration
  • Euphoria
  • Insomnia
  • Increased heart rate
  • Increased blood pressure
  • Reduced appetite
  • Cardiovascular collapse, death
  • Dilated pupils

Long-Term Effects:

  • Damage to brain cells containing serotonin
  • Over time, reduced level of dopamine resulting in Parkinson's-like symptoms
  • Weight loss
  • Confusion
  • Tremors
  • Convulsion
  • Paranoia
  • Hallucinations
  • Damage to nerve cells, causing strokes
  • Cardiovascular collapse, death

Effects from Withdrawal:

  • Irritability
  • Anxiety
  • Paranoia
  • Aggressiveness
  • Fatigue and long periods of sleep
  • Depression

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.

ABOVE: Psychology Today Diagnosis Dictionary: Amphetamines; last reviewed Jan. 10, 2005; captured Jan. 8, 2008.

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. Methamphetamine prompts 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, the burst of energy comes at a price. A “speed crash” always follows the high and may leave the person feeling nauseous, irritable, depressed and extremely exhausted.

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

  • Dry Mouth
  • Loss of appetite
  • Headache
  • Difficulty falling asleep (insomnia)
  • Nervousness including agitation, anxiety and irritability
  • Addiction

Less Common Side Effects

  • High blood pressure
  • Rapid pulse rate
  • Tolerance (constant need to raise the dose)
  • Feelings of suspicion and paranoia
  • Visual hallucinations (seeing things that are not there)
  • Depression
  • Cocaine craving
  • Dermatoses (infected or diseased skin)
  • Urinary tract infection
  • Infection or viral infection
  • Elevated ALT enzyme levels in the blood (signaling liver damage)

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:

  • Restlessness
  • Tremor
  • Aggression
  • Hallucinations
  • Panic states
  • Hyperreflexia (overactive reflexes, which can include twitching or spasms)
  • Personality changes
  • Symptoms of depression
  • Seizures or abnormal EEGs
  • High blood pressure
  • Rapid heart beat
  • Swelling of hands/feet/ankles (for example, numbing of the fingertips)
  • Delusions
  • Sweating
  • Vomiting
  • Dehydration
  • Unexplained muscle pain
  • Lower abdominal pain
  • Rhabdomyolysis and kidney damage
  • Chronic abuse can manifest itself as psychosis, often indistinguishable from schizophrenia

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.

Adderall-Induced Psychosis

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 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.”

NY Times: Children's A.D.D. Drugs Don't Work Long-Term

The NY Times, in an op-ed article by L. Alan Sroufe, a professor emeritus of psychology at the University of Minnesota's Institute of Child Development, stated the following:

“Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects... Many parents who take their children off the drugs find that behavior worsens, which most likely confirms their belief that the drugs work. But the behavior worsens because the children's bodies have become adapted [because the drugs are habit-forming] to the drug. Adults may have similar reactions if they suddenly cut back on coffee, or stop smoking.”

Parents might want to consider another approach.

ABOVE: L. Alan Sroufe, “Ritalin Gone Wrong: Children's A.D.D. Drugs Don't Work Long-Term,” New York Times, pg SR1, NY ed, 1/28/2012.
“Ritalin and amphetamine both produce gross reductions in blood flow to the brain thereby creating the conditions for stroke.”
Decreased blood flow to the brain plays a major role in brain disorders, including Alzheimer's.
ABOVE: Breggin, P.R. The Ritalin Fact Book: what your doctors won't tell you about ADHD and stimulant drugs; Perseus Books Group, 2002. 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. J Alzheimers Dis. 2011;23(3):375-89. doi: 10.3233/JAD-2010-090700.

What are the differences between the various Amphetamines?

BRAND GENERIC
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]
  • ALTERNATE NAMES:
  • 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.