Category:Psychostimulants: Difference between revisions

The psychostimulants are the medicines that quicken activity in the nervous system, producing wakefulness, alertness, and a sense of energy. They run from the mild stimulants of everyday life, caffeine above all, to the powerful amphetamines, and their history returns again and again to a single difficulty: the qualities that make a psychostimulant useful are the same qualities that make it liable to misuse. The oldest of them belongs to a plant. For thousands of years the peoples of the South American Andes have chewed the leaves of the coca shrub for endurance and against the hardship of labor at high altitude, and European voyagers carried the leaf home.^[1] Around 1859 the German chemist Albert Niemann isolated the leaf's active alkaloid and gave it the name cocaine.

Interest moved quickly. In 1884 the Viennese ophthalmologist Karl Koller showed that cocaine could numb the eye for surgery, a genuine and lasting advance and the seed of every local anesthetic since; in the same year Sigmund Freud published Über Coca, pressing cocaine as a remedy for many complaints, among them the morphine dependence of a friend. Freud's enthusiasm aged badly, the friend developed a severe cocaine problem instead, and through the 1880s reports of addiction and cardiac harm accumulated.^[2] Cocaine was sold all the same, lavishly and with extravagant claims, in coca wines and tonics and patent medicines, and in the first formula of Coca-Cola; as with the opioids of the same era, that open period ended in regulation, and the United States Harrison Narcotics Act of 1914 confined cocaine to prescription use.^[1] Cocaine then receded for half a century, returning only late in the twentieth century as powder and then as crack.

The synthetic psychostimulants have a separate origin. Amphetamine was first made in 1887, by the chemist Lazăr Edeleanu, but lay unexamined as a medicine for four decades; only in the late 1920s was its pharmacology studied, at first as a substitute for scarce ephedrine.^[3] It reached the United States in 1933 in Benzedrine, an over-the-counter inhaler for nasal congestion, and was soon pressed for low mood and for weight loss; methamphetamine followed for similar uses. Then, in 1937, the psychiatrist Charles Bradley, treating children at a home in Rhode Island, gave Benzedrine to young patients and saw, against all expectation, that it steadied their behavior and their schoolwork rather than exciting them.^[4] Bradley's observation was set aside for a quarter-century, but it was the foundation of the modern psychostimulant treatment of what is now called attention-deficit/hyperactivity disorder; methylphenidate, synthesized in 1944 and later sold as Ritalin, became and remains a mainstay of that treatment.

Amphetamine and methamphetamine were used very widely in the mid-twentieth century, by militaries against fatigue and by the public for weight and for mood, and a reaction followed. The recognition of dependence, and of a stimulant psychosis that can resemble schizophrenia, together with mounting non-medical use, brought the psychostimulants under the United States Controlled Substances Act of 1970.^[4] In the twenty-first century the psychostimulants have become a major part of overdose mortality: deaths involving cocaine and deaths involving methamphetamine both climbed steeply through the 2010s and into the 2020s, most of them also involving illicitly manufactured fentanyl.^[5] The prescription psychostimulants, by contrast, are seldom involved in fatal overdose, though they too can be misused.

The psychostimulants act mainly by raising the signaling of the monoamine neurotransmitters, dopamine and noradrenaline above all, though they do so by different routes: cocaine blocks the reuptake of these messengers, while amphetamine also drives their release, and the everyday stimulant caffeine works differently again, by blocking the receptors for adenosine. That these substances act on these systems is well established; how that action produces the whole range of effects, the therapeutic steadying, the euphoria, and the slide into dependence, is more complex and remains under study. This category collects the wiki's psychostimulant pages, from the mild stimulants of food and drink to the prescription medicines and the large and growing family of designer stimulants.

The psychostimulants run from the mild stimulants of everyday life, through the prescription medicines, to a large and fast-growing family of designer stimulants sold on the unregulated market.

• Everyday psychostimulants: the mild stimulants of food, drink, and tobacco, caffeine, theophylline, theacrine, and nicotine.
• Classical psychostimulants: cocaine; the amphetamines dextroamphetamine, mixed amphetamine salts, lisdexamfetamine, and methamphetamine; the phenidates methylphenidate and dexmethylphenidate; and the older agents ephedrine, pseudoephedrine, cathinone (the stimulant alkaloid of khat), propylhexedrine, fenethylline, and the parent compound phenethylamine.
• Wakefulness-promoting agents (eugeroics): modafinil, armodafinil, adrafinil, solriamfetol, and pitolisant.
• Synthetic cathinones, the cathinone-derived stimulants often sold as "bath salts": mephedrone, methylone, MDPV, alpha-PVP, alpha-PHP, pentedrone, ethylone, butylone, ephylone, 3-MMC, methcathinone, ethcathinone, hexedrone, N-Ethylhexedrone, N-Ethylpentedrone, and mexedrone.
• Other designer and research-chemical stimulants: the fluorinated amphetamines 2-FA, 2-FMA, 3-FA, 3-FMA, 4-FA, and 4-FMA; the novel methylphenidate analogs ethylphenidate, isopropylphenidate, 4F-MPH, 4F-EPH, 3,4-CTMP, and methylnaphthidate; and the further novel stimulants 2-AI, NM-2-AI, desoxypipradrol, cyclazodone, methiopropamine, RTI-111, bromantane, prolintane, and phenylpiracetam.
• Related entactogens: MDMA, MDA, and MDEA, grouped here for their stimulant character although they act as entactogens as well.

This category indexes the psychostimulants: the substances whose primary action is to raise activity in the nervous system, chiefly by increasing monoamine signaling, together with caffeine and the other mild stimulants that act by a different route. Membership runs from the everyday stimulants of food and drink, through the prescription medicines for attention-deficit/hyperactivity disorder and for the disorders of wakefulness, to the synthetic cathinones and other research-chemical stimulants of the unregulated market.

The psychostimulants span both medicine origins. Cocaine, caffeine, ephedrine, and the khat alkaloid cathinone reached use through a long traditional relationship with their source plants, while amphetamine, methylphenidate, modafinil, and the designer stimulants are creations of the laboratory; for that reason this category sits under both Plant and Pharmaceutical. MDMA and its relatives are indexed here for their stimulant character although they are primarily entactogens. Following the wiki's multi-membership convention, a medicine is indexed wherever its pharmacology and its uses warrant.

Each psychostimulant indexed here has its own page, built on the wiki's standard structure for a medicine: a history-first account, then pharmacology, indications, adverse effects, and interactions. Alongside the grouping above, the wiki maintains a set of related subcategories, among them the amphetamines, the methylphenidates, the eugeroics, the xanthines, and the agents used for attention-deficit/hyperactivity disorder that are not themselves stimulants.

This is one of the wiki's MedCategory class-overview pages. It carries the MedCategory and MedCategoryFull marker tags; the second suppresses the member list that MediaWiki would otherwise generate automatically, leaving the curated index above as the only one the reader sees. Because the class spans both origins, the category sits beneath Plant and Pharmaceutical alike, and beneath Medicines.