J Korean Med Assoc.  2018 Aug;61(8):502-508. 10.5124/jkma.2018.61.8.502.

Proper administration of psychostimulants

• Nam B

• KMID: 2428825
• DOI: http://doi.org/10.5124/jkma.2018.61.8.502

Abstract

Psychostimulants are a broad class of sympathomimetic drugs that include drugs of abuse, such as illegal substances, as well as therapeutic drugs, such as methylphenidate and modafinil. The common effect of psychostimulants is to improve motivation, mood, movement, energy, wakefulness, arousal, anorexia and attention. Methylphenidate and modafinil are psychostimulants used in the treatment of attention deficit hyperactivity disorder and narcolepsy. They have also been found to be effective for treating certain cognitive disorders that result in secondary depression or profound apathy, obesity, cancer-related fatigue as well as in specific treatment-resistant depressions as an augmentation therapy with antidepressants. Psychostimulants are also used in an non-medical manner, such as cognitive and/or performance enhancers in healthy population. However, the most limiting adverse effect of psychostimulants is their vulnerability to psychological and physical dependence. Therefore, the abuse and misuse of stimulants, including methylphenidate and modafinil, for the purpose of neuroenhancement is an issue of concern throughout the world including Korea. Although several recent studies have reported on the cognitive and performance enhancement effects of methylphenidate and modafinil in healthy population, psychostimulants should be administered with discretion in the light of their potential adverse effects and the lacks of long-standing efficacy.

Keyword

Methylphenidate; Modafinil; Neuroenhancement

MeSH Terms

Anorexia
Antidepressive Agents
Apathy
Arousal
Attention Deficit Disorder with Hyperactivity
Depression
Fatigue
Korea
Methylphenidate
Motivation
Narcolepsy
Obesity
Street Drugs
Sympathomimetics
Wakefulness
Antidepressive Agents
Methylphenidate
Street Drugs
Sympathomimetics

Reference

1. Wood S, Sage JR, Shuman T, Anagnostaras SG. Psychostimu-lants and cognition: a continuum of behavioral and cognitive activation. Pharmacol Rev. 2014; 66:193–221.

2. Sadock BJ, Ruiz P, Sadock VA, Kaplan HI. Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Philadelphia: Lippincott Williams & Wilkins;2015.

3. Korean Neuropsychiatric Association. Textbook of neuropsychiatry. 3th ed. Seoul: IMis Company;2017.

4. Na KS, Lee SI. Effect of methylphenidate on learning in normal population. J Korean Acad Child Adolesc Psychiatry. 2012; 23:49–56.

5. Choi JH, Lee SM. Safety issues in neuroenhancement. Korean J Med Ethics. 2014; 17:349–362.

6. Schmidt A, Müller F, Dolder PC, Schmid Y, Zanchi D, Egloff L, Liechti ME, Borgwardt S. Acute effects of methylphenidate, modafinil, and MDMA on negative emotion processing. Int J Neuropsychopharmacol. 2018; 21:345–354.

7. Wang D, Bai XX, Williams SC, Hua SC, Kim JW, Marshall NS, D'Rozario A, Grunstein RR. Modafinil increases awake EEG activation and improves performance in obstructive sleep apnea during continuous positive airway pressure withdrawal. Sleep. 2015; 38:1297–1303.

8. Park JA, Jang HS, Jeong SH, Ha JH, Lee H, Lee MG. Effect of modafinil and methylphenidate on sleep-wake architecture and EEG power spectra in rats. Korean J Psychopharmacol. 2009; 20:181–193.

9. Kim DS. Studies on application of psychoactive drugs for relieving of combat fatigue. J Korea Inst Mil Sci Technol. 2010; 13:689–698.

10. Borghol A, Aucoin M, Onor I, Jamero D, Hawawini F. Modafinil for the improvement of patient outcomes following traumatic brain injury. Innov Clin Neurosci. 2018; 15:17–23.

11. Minton O, Richardson A, Sharpe M, Hotopf M, Stone PC. Psychostimulants for the management of cancer-related fatigue: a systematic review and meta-analysis. J Pain Symptom Manage. 2011; 41:761–767.

12. Dalal S, Melzack R. Potentiation of opioid analgesia by psychostimulant drugs: a review. J Pain Symptom Manage. 1998; 16:245–253.

13. Abikoff H, Hechtman L, Klein RG, Weiss G, Fleiss K, Etcovitch J, Cousins L, Greenfield B, Martin D, Pollack S. Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. J Am Acad Child Adolesc Psychiatry. 2004; 43:802–811.

14. Yoo HJ, Yang SJ, Shin D, Kang H, Kim BN, Kim JH, Ahn D, Yoo HK, Cheon KA, Hong H. The Korean practice parameter for the treatment of attention-deficit hyperactivity disorder(III): pharmacologic treatment. J Korean Acad Child Adolesc Psychiatry. 2007; 18:16–25.

15. Park JP, Lee JI, Jhin HK, Min HJ, Hwang JW, Kim Y. Clinical characteristics of methylphenidate use in Korean children and adolescents with autism spectrum disorder: a retrospective study. J Korean Acad Child Adolesc Psychiatry. 2012; 23:154–160.

16. Westfall TC, Westfall DP. Adrenergic agonsists and antagonists. In : Brunton LL, Lazo JS, Parker KL, editors. Goodman and Gilman's the pharmacological basis of therapeutics. 11th ed. New York: McGraw-Hill;2011. p. 299–300.

17. Berridge CW, Devilbiss DM, Andrzejewski ME, Arnsten AF, Kelley AE, Schmeichel B, Hamilton C, Spencer RC. Methylphenidate preferentially increases catecholamine neurotransmission within the prefrontal cortex at low doses that enhance cognitive function. Biol Psychiatry. 2006; 60:1111–1120.

18. Hannestad J, Gallezot JD, Planeta-Wilson B, Lin SF, Williams WA, van Dyck CH, Malison RT, Carson RE, Ding YS. Clinically relevant doses of methylphenidate significantly occupy norepinephrine transporters in humans in vivo. Biol Psychiatry. 2010; 68:854–860.

19. Wilens TE, McBurnett K, Bukstein O, McGough J, Greenhill L, Lerner M, Stein MA, Conners CK, Duby J, Newcorn J, Bailey CE, Kratochvil CJ, Coury D, Casat C, Denisco MJ, Halstead P, Bloom L, Zimmerman BA, Gu J, Cooper KM, Lynch JM. Multisite controlled study of OROS methylphenidate in the treatment of adolescents with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med. 2006; 160:82–90.

20. Korean College of Neuropsychopharmacology. Clinical neuropsycho pharmacology. Seoul: Sigma Press;2014.

21. Koo YJ, Lee MS, Shin DW, Kim EJ, Kang JW, Cho SC. Neurobiology of attention-deficit/hyperactivity disorder and the action mechanism of OROS methylphenidate. J Korean Acad Child Adolesc Psychiatry. 2012; 23:Suppl. S5–S11.

22. Kim HW, Ko BJ, Park TW, Shin YO, Lee JS, Chung US, Cho IH, Choi TY, Bahn GH. Safety and tolerability of OROS methylphenidate for the treatment of ADHD. J Korean Acad Child Adolesc Psychiatry. 2012; 23:Suppl. S24–S45.

23. Bastuji H, Jouvet M. Successful treatment of idiopathic hypersomnia and narcolepsy with modafinil. Prog Neuropsychopharmacol Biol Psychiatry. 1988; 12:695–700.

24. Hwang JW. Non-stimulant medications in the treatment of attention-deficit hyperactivity disorder. J Korean Acad Child Adolesc Psychiatry. 2008; 19:72–82.

25. Kumar R. Approved and investigational uses of modafinil: an evidence-based review. Drugs. 2008; 68:1803–1839.

26. Wong YN, King SP, Simcoe D, Gorman S, Laughton W, McCormick GC, Grebow P. Open-label, single-dose pharmacokinetic study of modafinil tablets: influence of age and gender in normal subjects. J Clin Pharmacol. 1999; 39:281–288.

27. Minzenberg MJ, Carter CS. Modafinil: a review of neurochemical actions and effects on cognition. Neuropsychopharmacology. 2008; 33:1477–1502.

28. Federici M, Latagliata EC, Rizzo FR, Ledonne A, Gu HH, Romigi A, Nistico R, Puglisi-Allegra S, Mercuri NB. Electrophysiological and amperometric evidence that modafinil blocks the dopamine uptake transporter to induce behavioral activation. Neuroscience. 2013; 252:118–124.

29. US Food and Drug Administration. Modafinil (marketed as Provigil): serious skin reactions. Rockville: US Food and Drug Administration;2007.

30. Substance Abuse and Mental Health Services Administration. Results from the 2007 National Survey on Drug Use and Health: national findings. Rockville: Department of Health and Human Services;2008.

31. Bright GM. Abuse of medications employed for the treatment of ADHD: results from a large-scale community survey. Medscape J Med. 2008; 10:111.

32. Repantis D, Schlattmann P, Laisney O, Heuser I. Modafinil and methylphenidate for neuroenhancement in healthy individuals: a systematic review. Pharmacol Res. 2010; 62:187–206.

33. Goncalves J, Baptista S, Silva AP. Psychostimulants and brain dysfunction: a review of the relevant neurotoxic effects. Neuropharmacology. 2014; 87:135–149.