Stimulant dependents, medical

A comprehensive assessment of the stimulant-dependent patients psychological, medical, forensic, and drug use history may be difficult, because information may be incomplete or unreliable. In recognition of this deficiency, it is important that the patient receives a thorough physical examination, as well... 

Kampman KM (2008). The search for medications to treat stimulant dependence. Addiction Science Clinical Practice, 4, 28-35... 

Dependence and withdrawal can occur with all of the stimulants. Cocaine is one of the most strongly reinforcing drugs in self-administration paradigms in animals and also has a psychological withdrawal syndrome. A typical pattern of withdrawal includes a ravenous appetite, exhaustion, and mental depression, which may last for several days after the drug is withdrawn. Because tolerance develops quickly, abusers may take large doses, compared with those used medically, for example, as anorexiants. 

Herbal medications are drugs in every sense of the word. They chemically modify bodily processes and can have therapeutic or harmful effects, depending on how they are used. However, there are a few general differences between herbal and pharmaceutical drugs (Tyler 1994). Herbal drugs tend to be more dilute than pharmaceutical drugs (table 1.1). For example, caffeine is available in 200 mg tablets to produce stimulation. Coffee contains 1-2% caffeine, so in order to get the same amount of caffeine one must use 20 g of coffee bean. Similarly, aspirin is... 

Nausea is a common early side effect of all SSRIs. Early nausea is probably attributable to the stimulation of serotonin type 3 (5-HT3) receptors in the gastrointestinal tract, which downregulate after several weeks of treatment. Hence this side effect is both dose dependent and transient. Some patients report less nausea if they take the medication with food. Although rarely needed, medication that blocks the 5-HT3 receptor (e.g., ondansetron) can be used to reduce SSRI-induced nausea. 

Modafinil is a stimulant medication used to improve wakefulness in patients with narcolepsy, obstructive sleep apnea/hypopnea syndrome (as adjunct to standard treatments for the underlying disorder), and shift work sleep disorder. Controlled and open trials provided data on the efficacy and safety of modafinil in patients with narcolepsy (Besset et al. 1996 Billiard et al. 1994 Broughton et al. 1997 Mitler et al. 2000 U.S. Modafinil in Narcolepsy Multicenter Study Group 1998, 2000). Modafinil has a long duration of action and low potential for dependence and may be a reasonable first choice in the treatment of mild to moderate narcolepsy (Silber 2001). There is also considerable interest in the potential use of modafinil in the treatment of ADHD, and studies are in progress. 

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