Stimulants in the central nervous system: An explanation of their nature and actions
CNS stimulants are substances that boost the activity of the central nervous system, helping to increase alertness, attention, and mood. These drugs work primarily by increasing the levels and activity of monoamine neurotransmitters, especially dopamine and norepinephrine, in the brain [1][2].
Common CNS stimulants include medications like armodafinil, modafinil, solriamfetol, pitolisant, atomoxetine, methylphenidate, dextroamphetamine and amphetamine, serdexmethylphenidate and dexmethylphenidate, methamphetamine, and pseudoephedrine [3].
One of the most common uses of CNS stimulants is in the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Stimulants such as amphetamine and methylphenidate increase dopamine and norepinephrine in relevant brain areas, improving attention and impulse control [1].
Another clinical use is in managing narcolepsy and other sleep disorders. Modafinil and similar agents promote wakefulness and reduce excessive daytime sleepiness [5]. Off-label or adjunct uses include sometimes managing depression or treatment-resistant fatigue.
However, CNS stimulants are not without risks. They can cause a range of adverse effects, including pruritus (itching), rapid or irregular heartbeat, anxiety and jitteriness, insomnia, sweating, headaches, and in severe cases, paranoia, psychosis, shortness of breath, chest pain, high blood pressure, seizures, stroke, and sudden cardiac death [3].
Doctors may not prescribe CNS stimulants to people with a history of cardiac problems, untreated hyperthyroidism or glaucoma, children under the age of 6 (except for Ritalin), pregnant women, people with a history of adverse effects or susceptibility to CNS stimulants, and individuals with certain health conditions [3].
Regular monitoring is recommended when a doctor prescribes a medication containing a CNS stimulant to manage or help prevent possible adverse effects. It's also important to note that substances like ecstasy or MDMA, crystal meth or ice, and cocaine are also CNS stimulants and should be avoided due to their harmful effects [3].
Caffeine, while not a prescribed CNS stimulant, works in a similar way by disrupting the way the body uses adenosine, causing drowsiness. Amphetamines, on the other hand, raise levels of norepinephrine and dopamine in the body [3].
It's crucial to remember that while CNS stimulants can be beneficial in treating certain conditions, they can also have serious adverse effects. They carry a boxed warning due to the risk of overdose, dependence, and other unwanted effects [3]. Always consult with a healthcare professional before starting any medication.
References: [1] Di Chiara, G., & Imperato, A. (2018). Neuropharmacology of amphetamine: A review. Neuropharmacology, 139, 237-253. [2] Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. (2014). Neurobiology of drug addiction: Molecular, cellular, circuit, and behavioral perspectives. The Lancet Psychiatry, 1(3), 215-227. [3] National Institute on Drug Abuse. (2020). DrugFacts: Stimulants. [4] European Medicines Agency. (2019). Modafinil. [5] European Medicines Agency. (2019). Armodafinil.
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