Methylphenidate

• I don’t know whether he thought that it might reduce pain or improve performance, but the idea of taking drugs before “going into battle” goes back to the beginning of recorded history.
• Indeed, we find frequent mentions of mead drinking by the warriors in Edinburgh in the seventh-century epic poem The Goddodin.
• These ancient warriors probably used alcohol to reduce anxiety and blunt the horrors they would face on the battlefield.

• Pervitin (methamphetamine) was given almost freely to all arms of the German war machine.
• The frontline Nazis called them Panzerschokolade (tank chocolate), due to the feelings of incredible strength and invincibility that the pills gave them.

Behavioural effects

The types of drugs taken by warriors can be lumped into three broad categories: depressants, hallucinogens and stimulants. Alcohol is a depressant that calms the nerves by reducing brain activity. Psychedelic mushrooms such as Amanita muscaria contain a variety of psychoactive substances. Hyoscyamus niger also has a variety of active compounds that cause hallucinations and, importantly, aggressive and combative behaviour.

• The word “groggy” meaning dazed and unsteady came from British navy sailors exhibiting this behaviour after their daily ration of rum and water (grog).
• The stimulants, but especially methamphetamine, would also lead to significant weight loss even after only a few days of use.
• Long-term use, as we saw with the Nazis, would probably lead to emaciated soldiers.

Smart drugs

• We have seen that soldiers take drugs before battles to calm nerves, deal with the horrors, reduce pain, tolerate lack of food and sleep and improve alertness.
• The stimulants include drugs such as amphetamine salt mixtures, methylphenidate and modafinil, while nootropics include piracetam, caffeine, cobalamin (vitamin B12), guarana, pyridoxine (vitamin B6) and vinpocetine.
• The integration of humans, technology and machines is thought to be the future of warfare and drugs that facilitate this are undoubtedly being researched by the military.

Post-traumatic stress disorder

• There is a long history of soldiers taking alcohol and other drugs to deal with the horrors of what they have seen, or the disappointment of life after leaving the army.
• These veterans are taking MDMA and psilocybin on doctors’ orders as part of their treatment for PTSD.
• Ketamine is useful for treating depression and LSD is also being tested for various psychiatric disorders.

Colin Davidson has previously received funding from the US National Institute on Drug Abuse (NIDA). He is a consultant with the Defence Science and Technology Laboratory (UK).

Stimulants are first-line drugs for children and adults diagnosed with attention-deficit hyperactivity disorder (ADHD). But how do they actually work?

First, let’s look at the brain

• Medical imaging indicates people with ADHD may have slight differences in their brain’s structure, the way their brain regions work together to perform tasks, and how their brain’s chemical messengers, called neurotransmitters, pass on information.
• These brain differences are associated with the symptoms of ADHD, including inattention, impulse control and problems with memory.

What stimulants are prescribed in Australia?

• The three main stimulants prescribed for ADHD in Australia are dexamfetamine, methylphenidate (sold under the brand names Ritalin and Concerta) and lisdexamfetamine (sold as Vyvanse).
• Dexamfetamine and methylphenidate have been around since the 1930s and 1940s respectively.

So how do they work for ADHD?

• Stimulants increase the amount of dopamine and noradrenaline in the tiny gaps between neurons, known as synapses.
• They do this by predominantly blocking a transporter that then prevents their re-uptake back into the neuron that released them.
• Amphetamines also increase the amount of dopamine the neuron releases into the synapse (the tiny gaps between neurons).

What effect do they have on ADHD symptoms?

We still don’t fully understand the underlying brain mechanisms that change behaviour in people with ADHD. But research shows stimulants that modulate noradrenaline and dopamine can improve brain processes such as:
They can also improve general behaviour, such as self-control, not talking over the top of others, and concentration. These behaviours are important for social interactions. Stimulants reduce ADHD symptoms in about 70% to 80% of children and adults who take them. Some people will notice their symptoms improve right away. Other times, these improvements will be more noticeable to parents, carers, teachers, colleagues and partners.

Not everyone gets the same dose

The optimal stimulant dose varies between individuals, with multiple dosage options available. This enables a “start low, go slow” approach, where the stimulant can be gradually increased to the most effective dose for the individual.

• Dexamfetamine and methylphenidate are available in immediate-release preparations.
• As these have short half-lives (meaning they act quickly and wear off rapidly), they are often taken multiple times a day – usually in the morning, lunch and afternoon.
• Methylphenidate is also available in long-acting tablets (Concerta) and capsules (Ritalin LA).

What are the side effects?

The most common side effects are sleep problems and decreased appetite. A recent study showed children and young people taking methylphenidate for ADHD were around 2.6 times more likely to have sleep problems and 15 times more likely to have a decreased appetite than those not taking methylphenidate. Headache and abdominal pain are also relatively common.

Can someone without ADHD take a stimulant to improve productivity?

• As stimulants increase dopamine, they can cause euphoria and a heightened sense of wellbeing.
• A common myth about stimulant medicines is they can improve the concentration and productivity of people without ADHD.
• At each of the sessions, participants were given either a placebo or a stimulant before completing the task.
• Read more:
  ADHD medications have doubled in the last decade – but other treatments can help too

Mary Bushell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

• Today, GreenShield introduces its 2023 GreenShield Administration Drug Trends Report , revealing key insights surrounding three main therapeutic categories that go beyond Ozempic.
• "In the ever-changing world of healthcare, GreenShield's 2023 Administration Drug Trends Report reveals a compelling narrative, with an overall rise in utilization rates - driven by new therapies and changes in how plan members approach their health," said Mark Rolnick, Executive Vice President, Head of GreenShield Administration.
• This year's report provides data based on +32 million claims from over two million drug claimants processed by GreenShield Administration this year.
• Beyond its annual Drug Trends report, GreenShield Administration unlocks better health for all through integrated health and benefits solutions for more than 6 million Canadians from coast-to-coast.

• In addition, both doses of SDX were generally better tolerated compared to Ritalin and fewer subjects experienced cardiovascular adverse events after SDX compared to Ritalin.
• Lastly, vital signs after a single oral dose of 200 mg SDX (the highest dose tested) were comparable to Ritalin IR 80 mg and Ritalin LA 80 mg.
• The results demonstrate a robust safety profile for SDX, positioning it as a promising option for treating sleep disorders characterized by excessive daytime sleepiness.
• Details of Zevra’s poster presentation are as follows:
  Sr. Vice President of Clinical Development, Zevra Therapeutics