Psychostimulant use and the brain

Addiction. 2019 Nov;114(11):2065-2077. doi: 10.1111/add.14708. Epub 2019 Jul 19.

Abstract

Psychostimulant users are typically young adults. We have conducted a narrative review of neuropsychiatric harms associated with the psychostimulants methamphetamine/amphetamine, cocaine and 3,4-methylenedioxymethamphetamine (MDMA), focusing on epidemiological factors, common clinical presentations, underlying causal mechanisms and treatment options. The major neuropsychiatric harms of psychostimulant use are stroke, neurocognitive impairment, Parkinson's disease, seizures and psychotic illness. These arise through a combination of acute monoamine release, longer-term neurotransmitter effects and indirect effects. These effects are moderated by factors in the individual and in the pattern of substance use. Neuropsychiatric harms associated with psychostimulant use can thus lead to severe long-term impairment.

Keywords: Amphetamine; MDMA; Parkinson's disease; cocaine; methamphetamine; neurocognition; psychosis; psychostimulants; seizure; stroke.

Publication types

  • Review

MeSH terms

  • Amphetamine / adverse effects
  • Amphetamine-Related Disorders / metabolism
  • Amphetamine-Related Disorders / physiopathology
  • Brain / metabolism
  • Brain / physiopathology
  • Central Nervous System Stimulants / adverse effects*
  • Cocaine / adverse effects
  • Cocaine-Related Disorders / metabolism
  • Cocaine-Related Disorders / physiopathology
  • Cognitive Dysfunction / chemically induced*
  • Cognitive Dysfunction / metabolism
  • Cognitive Dysfunction / physiopathology
  • Humans
  • Methamphetamine / adverse effects
  • N-Methyl-3,4-methylenedioxyamphetamine / adverse effects
  • Parkinson Disease, Secondary / chemically induced*
  • Parkinson Disease, Secondary / metabolism
  • Parkinson Disease, Secondary / physiopathology
  • Psychoses, Substance-Induced / etiology*
  • Psychoses, Substance-Induced / metabolism
  • Psychoses, Substance-Induced / physiopathology
  • Seizures / chemically induced*
  • Seizures / metabolism
  • Seizures / physiopathology
  • Stroke / chemically induced*
  • Stroke / metabolism
  • Stroke / physiopathology

Substances

  • Central Nervous System Stimulants
  • Methamphetamine
  • Amphetamine
  • Cocaine
  • N-Methyl-3,4-methylenedioxyamphetamine