Comorbidity of mental disorders and substance use: a brief guide for the primary care clinician
3.4 Stimulants (including methamphetamine)
Cocaine, dexamphetamine, methamphetamine (including crystal and ice), ecstasy (3,4 – methylenedioxymethamphetamine, MDMA), methylphenidate, ephedrine, pseudoephedrine (Sudafed)
Stimulants are drugs that are purported to enhance sociability, confidence and alertness while reducing inhibition. The sensation of euphoria and wellbeing associated with the use of stimulants makes it highly sought after. However, these effects are usually only short lasting.
The physiological effects of stimulants include increased heart rate, blood pressure and temperature. Amphetamines, in general, reduce coordination, increase risk taking and are associated with an increase in the incident of road accidents.
Effects sought by user: Euphoria, empathy, enhanced sociability, increased energy level and stamina, and appetite suppression.
Associated harms: Tachycardia, hypertension, seizures, arrhythmias, increased risk taking including sexual activity and dangerous driving, paranoia, fear reduction, hallucinations, tremor, mydriasis, dehydration, diaphoresis, hyponatremia, acute renal failure, hypothermia, nausea, muscle cramping, jaw clenching, jitteriness, racing thoughts followed by periods of depression and low energy, anxiety, depression, paranoia and risk of suicide.
Injecting drug use is also associated with those risks described above for opioids. Problems associated with injecting drug use include: scarred or collapsed veins, abscesses, bacterial infections, blood borne viruses (e.g. hepatitis B and C, Human Immunodeficiency Virus [HIV]), thrombophlebitis, intravascular sepsis, endocarditis, accidental arterial injection and peripheral ischaemia.
Longer term structural brain changes result in memory problems, reduced problem solving ability, impaired concentration and personality change have been reported with heavy use.
Overdose: Low to medium risk of overdose for oral use. However, there is a high risk of overdose associated with smoking or injecting use.
Withdrawal: Depression, dysphoria, fatigue, exhaustion and somnolence and loss of appetite lasting up to two weeks.
Following prolonged use, insomnia, persistent craving, intense dreaming and irritability may ensue and last several weeks or months.
Psychological presentations commonly associated with use (likely to resolve on cessation of substance use): Psychosis(30-38), depression(39-54) and anxiety(11, 29, 43, 46, 50, 53-56).