Withdrawal symptoms from cocaine

Modified and reprinted with permission from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed.r text revision. Washington, DC American Psychiatric Association, 2000 Sofuoglu M, Dudish-Poulsen S, Poling J, et al. The effect of individual cocaine withdrawal symptoms on outcomes in cocaine users. Addict Behav 2005,30 1 125-1134 and Patten SB, Barbui C. Drug-induced depression a systematic review to inform clinical practice. Psychoth Psychosom 2004 73 207-215. 

Modafinil (Fig. 18.12) is also a non-amfetamine with psychostimulant properties, used for the treatment of narcolepsy, ADHD, obstruaive sleep apnea/hypopnea syndrome and may show potential for the treatment of cocaine withdrawal symptoms. Inspection of the structural representation indicates that modafinil contains a diphe-nylmethyl moiety and hence is dissimilar from an... 

The treatment goals for withdrawal from ethanol, cocaine/ amphetamines, and opioids include (1) a determination if pharmacologic treatment of withdrawal symptoms is necessary, (2) management of medical manifestations of withdrawal such as hypertension, seizures, arthralgias, and nausea, and (3) referral to the appropriate program for substance abuse treatment. 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

The nature of the withdrawal symptoms depends upon the neurotransmitter systems which are the target of the drug. Thus cocaine and the amphetamines alleviate fatigue, cause anorexia and elevate mood withdrawal therefore results in feelings of fatigue, hyperphagia and depression. Abrupt withdrawal from the sedatives, such as barbiturates or following... 

Tolerance to the mood-altering effects and psychological dependency develop as with cocaine, and symptoms of withdrawal appear when the drug is stopped. Laboratory animals who have learned to self-administer amphetamines have been observed to choose drugs instead of food and water they die from exhaustion in their frantic efforts to feed their high. —... 

These natural reward centers have developed over the course of evolution to reinforce useful behaviors (e.g., pleasure, sexual satisfaction, eating, and drinking). It is believed that drugs such as cocaine and amphetamine directly stimulate these centers, while opiates free the pathways from inhibitory control. Nicotine, on the other hand, reaches the brain in as little as 10-20 seconds, where it stimulates nicotine receptors to cause dopaminergic neurons to release large quantities of dopamine. After a few hours, dopamine levels decline, causing withdrawal symptoms to readily appear (e.g., anxiety, irritability, and inattentiveness). When cigarette smokers say they need a smoke to steady their nerves, what they really mean is that they have to contend with nicotine withdrawal. 

Cocaine is usually legally classified as an addictive drug though withdrawal doesn t cause the abstinence syndrome seen in junkies. Cocaine withdrawal causes symptoms similar to those seen in withdrawal from amphetamines — depression, fetigue and listlessness. 

Cocaine (281) when sniffed or injected gives rise to a state of euphoria often followed by paranoid delusions. Although there are no withdrawal symptoms, as it does not cause physical dependence, it probably does more harm to brain and body than any other drug (282). There is a good case for its total prohibition, as it no longer serves any essential medical purpose, and, unlike heroin, there is no readily available natural source from which it may be manufactured. 

Opioids (especially methadone and heroin) are the most common cause of serious neonatal drug withdrawal symptoms. Other dmgs for which a withdrawal syndrome has been reported include phencyclidine (POP), cocaine, amphetamines, tricyclic antidepressants, phenothiazines, benzodiazepines, barbiturates, ethanol, clonidine, diphenhydramine, lithium, meprobamate, and theophylline. A careful dmg history from the mother should include illicit drugs, alcohol, and prescription and over-the-counter medications, and whether she is breast-feeding. 

Many animals will self-administer cocaine. Studies on honey bees Apis mellifera L.) show that cocaine intake increases both the frequency and vigor of their waggle dance to indicate the direction of food sources to their nest mates. They also suffer from withdrawal symptoms . Sound familiar ... 

For many years, the full scope of cocaine s addictiveness was not understood. The body s clues that it has become addicted—the symptoms of withdrawal from cocaine—are not as obvious as in other addictive drugs. Things like trouble sleeping, changes in energy levels, and increased depression are not always clear and can be explained by a variety of other factors. 

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