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PSYCHOSTIMULANTS

Kat, Jackie, Amy & Shelina


Presentation Outline
1. History
2. Listing of Psychostimulant Drugs
3. More Details on Some Common Drugs
4. Applications with Children & Adults
5. Characteristics & Mechanisms
6. Potential Negative Effects
7. Controversy
8. References
HISTORY
Psychostimulants have a long
history of medical use for the
treatment of childhood
psychiatric conditions (Pliszka,
1998).

1937
Bradleys study of the
therapeutic effects of Benzedrine
on children (Lange et al., 2010; Mayes &
Rafalovich, 2007).


1944
compound known as Ritalin was
first synthesized in 1944 by
Leandro Panizzon (Lange et al., 2010).

HISTORY
1955
Ritalin for children with
hyperkenetic behavior syndrome
(Mayes & Rafalovich, 2007).
1961
Ritalin approved by U.S. Food &
Drug administration in for use with
children with behavior problems
(Mayes & Rafalovich, 2007).

1967
NIMH awarded first grant to
study use of stimulants with
children (Mayes & Rafalovich, 2007).
By late 1960s, an estimated
150,000-200,000 American
children were being treated with
stimulants (Mayes & Rafalovich, 2007)
1970
media attention and increased
restrictions

History
1975
Pemoline (Cylert) was approved
by the FDA for use in the
treatment of ADHD

1999
NIMH (National Institute of
Mental Health) publishes results
from a 14-month study known as
the Multimodal Treatment Study
of ADHD (MTA Study) (Goodman,
2010)


1999
New delivery systems (Swanson,
2005)

2000
Concerta (Swanson, 2005)

2007
Vyvanse

warnings to ADHD medications
(Goodman, 2010)

Listing of Psychostimulant Drugs
Methylphenidate Hydrochloride (Concerta &
Ritalin)
Often the first choice for treating ADHD

Amphetamine (Adderall)
Usually the second choice

Dextroamphetamine Sulfate (Dexedrine)
Concerta (Methylphenidate
Hydrochloride)
Taken once/day, time-released formula (taken in
morning)

Dosage can be modified
With most psychostimulants, start low and work up

Not for children under 6 years

Drug manufacturers warn that it should not be taken by
children with significant anxiety, tics or Tourette's
syndrome
Ritalin (Methylphenidate Hydrochloride)
2 pills (one before breakfast, one before lunch) OR 1
slow release tablet (lasts 8 hours)

Dosage can be modified

Not for children under 6 years

Drug manufacturers warn that it should not be taken by
children with significant anxiety, tics or Tourette's
syndrome
Adderall (Amphetamine)
Taken once daily when waking up

Should not be taken by children with
high anxiety

Has not been studied in children
under 6 years old

Dexedrine (Dextroamphetamine Sulfate)
One extended release pill

Ages 6 and older

May exacerbate phonic and motor tics
Psychostimulants: Applications with Children and
Adults


Stimulant
Increases rate of physiologic
functioning (CNS)
Effect on Neurotransmitters
Psychostimulant

Has direct neurological effects:
-counteract lethargy
-reduce sleepiness
-improve concentration and focus


Increased alertness
Increased energy
Appetite suppression

Euphoria
Possible mood enhancer



-Widespread use: may include

clinical or recreational settings
Children and
adults
Adults
Children
Applications of Methylphenidate (Ritalin, Concerta) in
Children and Adults
Methylphenidate: improve attention, distractibility, impulsivity and
observable classroom behaviour in children with ADHD

Common
Alternative

Methylphenidate
Methylphenidate
ADHD (Ritalin)
Depression
Narcolepsy
Other cognitive
impairments-
e.g., TBI
Apathy
(Parkinsons)
(Elderly)
ODD/CD(reduce
aggression)
Applications of Amphetamine
(Adderall) in Children and Adults
Common
Alternative








Amphetamine
ADHD (Adderall) Narcolepsy
Amphetamine
Used by US fighter
pilots to increase
alertness
Appetite
suppressing effect:
obesity
Academic
enhancement in
college students
Sometimes used in
treatment resistant
depression
Dextroamphetamine Sulfate (Dexedrine) Applications
with Adults and Children
Common
Alternative
Dextroamphetamine Dextroamphetamine
ADHD
(Dexedrine)
Narcolepsy Obesity TBI
Characteristics
What are the mechanisms acting in the brain?
Depend on the drug class

Neurotrasmitters Involved:

Catecholamines (dopamine and norepinephrine)
amphetamines/methylphenidates

Serotonin
amphetamines

Mechanisms
Psychostimulants act to increase the levels of dopamine
within the synapse of nerve cells in the PFC by:
Push additional dopamine from a nerve cell to the
synapse
Disrupt DAT molecules and prevent dopamine re-
uptake
Reverse functions of DAT molecules causing
increased dopamine production
At high clinical doses amphetamines can:
Stimulate efflux of norepinephrine
Block reuptake of serotonin



Characteristics
Onset of action for amphetamine and methylphenidate
compounds is 20 mins - 1 hour after ingestions

Effects lasting 3 - 6 hours on average
depends on dosage, mechanism of drug chosen,
type of action (long, intermediate, short)
Characteristics
Substrate Action Medication Duration
Methylphenidate Short Ritalin, Focalin,
Methylin
3 4 hr

Intermediate Ritalin SR, Metadate ER,
Methylin ER
6 8 hr

Long Concerta,
Metadate CD, Ritalin LA
12 hr
8 10 hr

Amphetamine Short Dexedrine
Dextrostat
3 5 hr

Intermediate Adderall 4 8 hr

Long Dexedrine
Adderall XR
8 12 hr

(Carlate Psychiatry Report, 2003)
Negative Effects of Psychostimulants in
Children
Common Short Term Side Effects Potential Long Term Side Effects
Decreased appetite Slower growth (especially in first year
of taking meds)
Difficulty falling asleep
Stomachache
Headache
Short term side effects normally wear off after the first little while on meds, and with
dosage adjustments

Children who experience slower growth normally catch up in height and weight

Many psychostimulant medications have not been studied in children under the
age of 6

Dependency can occur with abuse of psychostimulant drugs

Generally safe to use
CONTROVERSY
Ethical considerations
Side effects
Addiction/Misuse
Role of the media

Controversy: Social/Ethical
Considerations
Is stimulant use means of socially controlling children?
By treating the restlessness of youth as a medical, rather than a moral,
challenge, those resorting to behavior-modifying drugs might deprive that child
of an essential part of this education. They might also encourage him to change
his self-understanding, by coming to look upon himself as governed largely by
chemical impulses and not by moral decisions grounded in some sense of what
is right and appropriate. (Singh, 2013)
Informed consent
Parents/Guardians must consent on behalf of the child. What occurs when
what is in the childs best interest is not agreed upon? (Taylor, 2013)


Controversy: Social/Ethical
Considerations
Standards of practice
Should medical interventions be used before attempting other
behavioral/social interventions?

Neuroenhancement

Controversy: Side Effects
Can the use of stimulants
cause stunted growth in
children?
No consensus in the research: some
studies indicate no effect while others
report growth attentuation; others
report it is dosage dependent (Negrao
& Vilijoen, 2011).

Can the use of stimulants
cause sudden death?
Stimulants have cardiovascular
effects increased heart rate and
blood pressure (Mazza et al., 2013)

Stimulants do not increase the risk of
cardiovascular events (Mazza et al.,
2013; Winterstein, 2013; Wilens et al.,
2006)

Controversy: Addiction/Misuse
Do children prescribed stimulants for ADHD become
addicted?
Children prescribed stimulant medication for ADHD are at no greater risk for
substance abuse (Greydanus)
Adolescents with ADHD who went untreated were 3-4 times more likely to use
illicit substances than adolescents who were treated with stimulant medication
(Greydanus)
Illicit drug use in adulthood is not associated with childhood stimulant
treatment of ADHD (Greydanus)
Greydanus,www.acha.org/Continuing_Education/docs/ACHA_Use_Misuse_of_
Stimulants_Article2.pdf)

Controversy: The Role of the Media
References
Bradley, C. (1950). Benzedrine and Dexedrine in the Treatment of Childrens Behavior
Disorders. Pediatrics, 5(1), 24-37.

Berridge, C. W., & Devilbiss, D. M. (2011). Psychostimulants as cognitive enhancers: The prefrontal cortex,
catecholamines and attention-defici/hyperactivity disorder.
Biological Psychiatry, 69(12), 101-111. doi: 10.1016/j.biopsych.2010.06.023

Busch, S.H. (2009). Medication treatment for ADHD: controversy abounds. Health Affairs, 28(5), 1549-
1550. doi: 10.1377/hlthaff.28.5.1549

Chatterjee, A., & Fahn, S. (2002). Methylphenidate treats apathy in Parkinson's disease. The Journal of
neuropsychiatry and clinical neurosciences, 14(4), 461-462.

Currie, J., Stabile, M., & Jones, L. E. (2013). Do Stimulant Medications Improve Educational and Behavioral
Outcomes for Children with ADHD? (No. w19105). National Bureau of Economic Research.

Goodman, D. W. (2010). Lisdexamfetamine dimesylate (vyvanse), a prodrug stimulant for attention-
deficit/hyperactivity disorder. Pharmacy and Therapeutics, 35(5), 273.



References
Gonalves, J., Baptista, S., & Silva, A. P. (2014). Psychostimulants and brain
dysfunction: a review of the relevant neurotoxic effects. Neuropharmacology.

Greydanus, D.E.
www.acha.org/Continuing_Education/docs/ACHA_Use_Misuse_of_Stimulants_Articl
e2.pdf

Carlat Psychiatry Report. (2003). Psychostimulants: bringing order out of chaos.
Retrieved from http://pro.psychcentral.com/2013/psychostimulants-bringing-order-
out-of-chaos/001371.html
Food & Drug Administration (FDA). Medication Guide - Adderall.
http://www.fda.gov/downloads/Drugs/DrugSafety/ucm085819.pdf
References
Haleem, D. J. (2013). Extending therapeutic use of psychostimulants: Focus on serotonin-1A receptor. Progress
in Neuro-Psychopharmacology and Biological Psychiatry, 46, 170-180.

Kollins, S. H. (2008). ADHD, substance use disorders, and psychostimulant treatment current literature and
treatment guidelines. Journal of Attention Disorders, 12(2), 115-125.

Lange, K.W., Reichl, S., Lange, K.M., Tucha, L., & Tucha, O. (2010). The history of attention deficit
hyperactivity disorder, 2(4): 241-255. Published online Nov 30, 2010. doi: 10.1007/s12402-010-0045-8

Liptzin, B., & Hobgood, C. (2011). Use of Antidepressants in Geriatric Patients.The Evidence-Based Guide to
Antidepressant Medications, 227.

Mazza, M., D'Ascenzo, F., Davico, C., Biondi-Zoccai, G., Frati, G., Romagnoli, E., ... & Gaita, F. (2013). Drugs
for attention deficithyperactivity disorder do not increase the mid-term risk of sudden death in children: A
meta-analysis of observational studies. International journal of cardiology, 168(4), 4320-4321.

Mayes, R., & Rafalovich, A. (2007). Suffer the restless children: the evolution of ADHD and paediatric
stimulant use, 190080. History of Psychiatry, 18(4), 435-457.


References
Negrao, B. L., & Viljoen, M. (2011). Stimulants and growth in children with attention-
deficit/hyperactivity disorder. Medical hypotheses, 77(1), 21-28.

Pajo, B., & Cohen, D. (2013). The problem with ADHD: Researchers constructions
and parents accounts. International Journal of Early Childhood,45(1), 11-33.

Partridge, B. (2013). A bubble of enthusiasm: How prevalent is the use of prescription
stimulants for cognitive enhancement?. In Cognitive Enhancement(pp. 39-47). Springer
Netherlands.

Pliszka, S. R. (1998). The use of psychostimulants in the pediatric patient.Pediatric
Clinics of North America, 45(5), 1085-1098.

References
Rosenberg, D.R. (2002). Psychostimulants. In Rosenberg, D.R., Davanzo, P.A., &
Gershon, S., Pharmacotherapy for child and adolescent psychiatric disorders (pp.
113-167). Retrived from
http://site.ebrary.com.ezproxy.lib.ucalgary.ca/lib/ucalgary/docDetail.action?docID
=10051456&p00=pharmacotherapy%20child%20adolescent
Singh, I. (2013). Not robots: children's perspectives on authenticity, moral agency and stimulant
drug treatments. Journal of medical ethics, 39(6), 359-366.

Stotz, G., Woggon, B., & Angst, J. (1999). Psychostimulants in the therapy of
treatment-resistant depression Review of the literature and findings from a
retrospective study in 65 depressed patients. Dialogues in clinical neuroscience,
1(3), 165.
Whyte, J., Vaccaro, M., Grieb-Neff, P., & Hart, T. (2002). Psychostimulant use in the
rehabilitation of individuals with traumatic brain injury. The Journal of head
trauma rehabilitation, 17(4), 284-299.

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