Stimulants (also called a central nervous system stimulant, psychostimulant, or colloquially an upper) are a class of psychoactive drugs that increase alertness. They are used for various purposes, such as enhancing attention, motivation, cognition, mood, and physical activity. Some stimulants occur in nature while others are synthetic. Common stimulants include caffeine, nicotine, cocaine , amphetamine, methamphetamine, methylphenidate, and modafinil. Some stimulants are subject to governmental regulation or prohibition because they can have adverse side effects including addiction, drug tolerance, drug withdrawal, psychosis, anxiety, insomnia, cardiovascular disease, and neurotoxicity. The misuse or abuse of stimulants can have serious adverse health and social consequences, such as overdose, substance dependence, crime, and violent behavior. Stimulants increase activity in the sympathetic nervous system. They often increase synaptic concentrations of excitatory neurotransmitters, particularly norepinephrine and dopamine. Other stimulants work by binding to the receptors of excitatory neurotransmitters (e.g., nicotine) or by blocking the activity of endogenous agents that promote sleep (e.g., caffeine). Stimulants can affect various functions, including arousal, attention, the reward system, learning, memory, and emotion. Effects range from mild stimulation to euphoria, depending on the specific drug, dose, route of administration, and inter-individual characteristics. Stimulants have a long history of use, both for medical and non-medical purposes. Archeological evidence from Peru shows that cocaine use dates back as far as 8000 B.C.E. Stimulants have been used to treat various conditions, such as narcolepsy, attention deficit hyperactivity disorder (ADHD), obesity, depression, and fatigue. They have also been used as recreational drugs, performance-enhancing substances, cognitive enhancers, and to promote aggression of combatants in wartime.
Definition Stimulant is an overarching term that covers many drugs including those that increase the activity of the central nervous system and the body, drugs that are pleasurable and invigorating, or drugs that have sympathomimetic effects. Sympathomimetic effects are those effects that mimic or copy the actions of the sympathetic nervous system. The sympathetic nervous system is a part of the nervous system that prepares the body for action, such as increasing the heart rate, blood pressure, and breathing rate. Stimulants can activate the same receptors as the natural chemicals released by the sympathetic nervous system (namely epinephrine and norepinephrine) and cause similar effects. Psychostimulant refers to a subset of substances within the stimulant drug class that act at the dopamine transporter (DAT), a protein that normally clears dopamine from the synaptic cleft. Amphetamine, methylphenidate, cocaine, and modafinil are examples of psychostimulants that promote arousal and affect task performance in a dose-dependent manner. Psychostimulants act at DAT by inhibiting dopamine reuptake or by initiating transporter-mediated dopamine efflux (i.e., reverse transport), thereby producing indirect dopamine agonist effects in the central nervous system. The DAT-mediated actions of psychostimulants contrast with other central nervous system stimulants that can overlap in behavioural effects, such as caffeine, a drug that promotes wakefulness primarily through antagonism of adenosine receptors.
Effects
Acute Stimulants in low doses, such as those prescribed to treat attention deficit hyperactivity disorder (ADHD), increase ability to focus, vigor, sociability, wakefulness, libido and may elevate mood or cause euphoria. However, in higher doses, stimulants may actually decrease the ability to focus, a principle of the Yerkes-Dodson law. Many, but not all, stimulants have ergogenic effects; that is, they enhance physical performance. Drugs such as ephedrine, pseudoephedrine, amphetamine and methylphenidate have well documented ergogenic effects, while cocaine has the opposite effect. Neurocognitive enhancing effects of stimulants, specifically modafinil, amphetamine and methylphenidate have been reported in healthy adolescents by some studies, and is a commonly cited reason among illicit drug users for use, particularly among college students in the context of studying. Still, results of these studies is inconclusive: assessing the potential overall neurocognitive benefits of stimulants among healthy youth is challenging due to the diversity within the population, the variability in cognitive task characteristics, and the absence of replication of studies. Research on the cognitive enhancement effects of modafinil in healthy non-sleep-deprived individuals has yielded mixed results, with some studies suggesting modest improvements in attention and executive functions while others show no significant benefits or even a decline in cognitive functions. In some cases, psychiatric phenomena may emerge such as stimulant psychosis, paranoia, and suicidal ideation. Acute toxicity has been reportedly associated with hyperhidrosis, panic attacks, severe anxiety, mydriasis, paranoia, aggressive behavior, psychosis, rhabdomyolysis, and punding. The violent and aggressive behavior associated with acute stimulant toxicity may partially be driven by paranoia. Most drugs classified as stimulants are sympathomimetic, meaning that they stimulate the sympathetic branch of the autonomic nervous system. This stimulation leads to effects such as mydriasis (dilation of the pupils), increased heart rate, blood pressure, respiratory rate and body temperature. When these changes become pathological, they are called arrhythmia, hypertension, and hyperthermia, and may lead to rhabdomyolysis, stroke, cardiac arrest, or seizures. However, given the complexity of the mechanisms that underlie these potentially fatal outcomes of acute stimulant toxicity, it is impossible to determine what dose may be lethal.
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