Stimulants have been used throughout human history for a variety of reasons. High levels of stress and the demanding nature of medical school make their usage among medical students particularly common. The most prevalent stimulant used by students is coffee, followed by tea and other forms of caffeine like sugary energy drinks. In addition, amphetamine-based medications for treating attention deficit hyperactivity disorder (ADHD) have been increasing in popularity, which many students take illicitly. Students report taking various forms of stimulants to promote cognitive enhancement, prolong wakefulness and retain focus for long periods of time. Moderate doses of caffeine and amphetamines would lead to enhanced alertness and concentration. However, large increases in dosage or frequency would lead to an increased risk of toxicity and adverse effects. The positive outcomes from stimulant consumption are often overshadowed by the negative side effects and incorrect dosage. Thus, it appears that usage of stimulants should be limited, in favor of a more sustainable approach to cognitive enhancement. This review analyzes the use of stimulants among the medical student community, consequences of misuse and discussed the healthy and organic approaches to lessen the stress and improve academic performance. This article also discusses the mechanisms of action, acceptable doses, additives, ingredients of stimulants commonly used by medical students for cognitive enhancement and the implications of long-term use as the stress of practicing medicine extends well beyond the medical school years. Students report taking various forms of stimulants to promote cognitive enhancement, prolong wakefulness and retain focus for long periods of time. Moderate doses of caffeine and amphetamines would lead to enhanced alertness and concentration. However, large increases in dosage or frequency would lead to an increased risk of toxicity and adverse effects. The positive outcomes from stimulant consumption are often overshadowed by the negative side effects and incorrect dosage. Thus, it appears that usage of stimulants should be limited, in favor of a more sustainable approach to cognitive enhancement. This review analyzes the use of stimulants among the medical student community, consequences of misuse and discussed the healthy and organic approaches to lessen the stress and improve academic performance. This article also discusses the mechanisms of action, acceptable doses, additives, ingredients of stimulants commonly used by medical students for cognitive enhancement and the implications of long-term use as the stress of practicing medicine extends well beyond the medical school years. The fluctuations in usage, overuse, and in some cases misuse of these stimulants have led to the recommendation that stimulant usage should be limited and the consumer should be more aware of the effects these compounds have. In order to address these concerns, this systematic review discusses how students and the institutions they are a part of should approach the topic and what actions should be implemented to ensure healthy practices. Through the analysis of existing literature, this paper aims to further the discussion of stimulant use among medical students, their mechanism of action, whether or not the intended outcomes are achieved, and the presence of side effects. methylphenidate or lisdexamfetamine was used Devise plans to curb stimulant use 5 De Bruyn et al., 2019 [ 9 ] Belgium NPS use among medical students 3159 medical students 237 used NPS during exams. methylphenidate, modafinil, and amphetamine. Underlying causes for NPS use need to be explored and addressed 6 Fallah et al., 2018 [ 10 ] Iran Stimulant use among medical students 260 medical students 49 (11%) used NPS. Ritalin, amphetamine Promote life skills, awareness of side effects of the NPS early in the school are proposed 7 Retief and Verster, 2016 [ 11 ] South Africa Prevalent of NPS use and correlations 252 fourth medical students 42 (17%) used NPS. 77 of them reported side effects (palpitations, insomnia, irritability, anxiety, etc.) Large usage of energy drinks with or without alcohol was found. Future work is needed to assess long-term and short-term side effects. 6 Usman et al., 2015 [ 22 ] Pakistan Estimate prevalence of energy drink consumption 233 medical students 121 (51%) reported consuming energy drinks Found high prevalence of energy drink consumption. Caffeine is found in several plant species, forms naturally in cacao beans and is extracted for widescale commercial uses [ 35 ]. Studies show that caffeine’s desired effects of increased attention and alertness are achieved at lower doses (<4 g) and some of its negative effects are seen at higher levels of consumption [ 35 ]. Some of its desired effects in particular include increased concentration, wakefulness, and faster reaction times. Long-term effects of moderate regular doses of caffeine may even reduce the risk of dementia and cognitive decline [ 36 ]. These effects are often sought for by individuals in physically and mentally demanding careers. found that compared to caffeine from other sources such as coffee, participants who consumed energy drinks had a significantly higher corrected QT interval and systolic BP two hours after consumption [ 43 ]. In terms of safety, the Food and Drug Administration (FDA) requires that all new drugs that However, this review may be relevant to students and professionals pursuing careers in various fields of medicine that require extensive educational training and long work hours. Further research is indicated to assess the effects of long-term use of stimulants on behavioral changes among medical students. Studies evaluating chronic use of psychostimulants and their effects of neuronal damage or changes in IQ levels are also indicated as the use of energy drinks is relatively new and the effects of chronic use are not well established.

Attention deficit hyperactivity disorder (ADHD) is a fairly common psychiatric disorder among children. It has substantial consequences in terms of quality of life for those experiencing it and their families. In managing ADHD symptoms medication plays an essential role, including stimulants such as methylphenidate being a key component. Nevertheless, concerns have been raised about possible adverse reactions connected to these drugs. Thus, in this systematic review, an extensive analysis was conducted aiming at understanding any negative repercussions specifically from prolonged exposure to these medications among patients diagnosed with ADHD. The methodology entailed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. While capturing relevant data through a meticulous search in various databases, filtered according to preset inclusion and exclusion criteria, 13 studies were considered for analysis. Conclusions indicate that the administration of stimulant medications can potentially translate into a small rise in blood pressure along with increased heart rate particularly when amphetamines are taken. However, no reports of notable serious cardiovascular events have emerged. In the domain of neuropsychiatry, it appears that long-term usage of methylphenidate generally bears no serious consequences, even though a hike in risk levels related to the occurrence of psychotic episodes was detected among those treated with amphetamines. Several gastrointestinal side effects including decreased appetite and stomach pain were reported, however, findings regarding ocular abnormalities or growth-related effects stood inconclusive. Therefore, based on this data the consensus is that stimulant medications do generate manageable and mild negative outcomes within the ADHD population. It is vital however to highlight the need for careful observation and further scientific inquiry to achieve a better grasp on both immediate a Children and adolescents taking these medications may experience different side effects such as reduced appetite, increased aggression, and physical symptoms like headaches and gastrointestinal issues [ 6 ]. Additionally, due to the dopaminergic activity of stimulant medications, long-term exposure has the potential to increase the risk of psychosis, as supported by existing literature [ 16 ]. Investigating the relationship between long-term stimulant treatment and negative neuropsychiatric effects is undoubtedly significant from a clinical standpoint but it poses a complex challenge in terms of finding definitive answers. 101 The data revealed that more than half of the patients experienced at least one side effect; however, most patients reported that intervention with medication had a positive impact, with marked improvement in academics and behavior. Omidi et al. (2021) [ 14 ] Prospective cohort study Children aged between 6 and 11 years, with the diagnosis of ADHD using DSM-V criteria referred to the psychiatric clinic of Ziaeian Hospital in Tehran, Iran. 100 Apart from a non-pathological increase in all indices after 3-month follow-up, short-term (3-month) treatment of ADHD children with CNS stimulants doesn’t show any statistically significant relationship with altered blood pressure indices. Methylphenidate causes mild reduction in height and weight when administered as a long-term therapy but these changes have a minimal clinical When used under proper medical supervision, long-term treatment with MPH is both safe and efficient in managing ADHD symptoms in children [ 40 ]. In a systematic review conducted by Krinzinger et al., it was found that there is variability in the methodologies and study designs used to investigate the long-term effects of MPH treatment [ 16 ]. However, the majority of studies indicate that extended use of MPH does not cause anxiety and irritability, especially for individuals beyond preschool age. Furthermore, evidence from studies examining substance abuse suggests that long-term MPH use has no negative outcomes. These findings suggest that children who undergo long-term MPH treatment may eventually experience blurred vision because of declining accommodation capacities [ 20 ]. Additionally, it is important to consider the potential presence of glaucoma when using stimulant medications. These medications have a mild anticholinergic effect and hinder the reuptake of noradrenaline, which can contribute to the development or worsening of angle closure glaucoma [ 46 ]. Furthermore, they have also been known to temporarily increase intraocular pressure without causing angle closure [ 47 ]. Moreover, individuals initiated on a blended regimen of both drug variants presented a heightened prevalence of side effects compared to those on a singular medication type [ 6 ]. Growth and Bone Age One area of concern regarding stimulant medication like MPH is its potential impact on growth and bone age in individuals with ADHD. Research suggests that the use of stimulants may result in a temporary decrease in growth velocity during the initial year of treatment [ 50 ]. However, most children eventually catch up to their expected growth trajectories. The long-term impact on final adult height remains uncertain, with conflicting findings reported [ 51 ]. When it comes to bone age, stimulant use may cause minor delays in skeletal maturation, however, these delays are reversible and generally not clinically significant [ 21 ]. In a study conducted by Carucci et al., the long-term effects of MPH use on height and weight were investigated. It was found that children and adolescents may experience slight impacts on their height and weight due to long-term MPH treatment for ADHD. Over two years, the group-level effects indicated a potential reduction in height gain of around 1.39 cm and weight gain of about 1.96 kg. Nonetheless, these symptoms are usually temporary and return to normal over time [ 2 ].

ysical growth, both when tested shortly after drug discontinuation and 6 months later. Additionally, they did not observe any major effects on cognitive (ie, reaction times, cognitive control) or motor behaviors (spontaneous locomotor activity) after chronic treatment following immediate or prolonged discontinuation. Therefore, the results of both articles suggest that chronic MPH or AMP started in peri-adolescence/adolescence at clinically relevant doses do not significantly alter DA system development nor do they affect physical growth in non-human primates. They also suggest that they do not sensitize the brain to drug rewards ( Gill et al , 2012 ) nor that they negatively affect cognitive or motor behaviors after discontinuation ( Soto et al , 2012 ). A limitation from these studies is that they are done in healthy animals and the long lasting effects from chronic treatment with stimulant medications may differ in individuals with ADHD. However, the findings, at least as they relate to substance use disorders, are consistent with those from long-term follow-up studies that showed no long-term effects—positive (ie, decreasing risk for substance use) or negative (increasing risk for substance use)—of clinical treatment with stimulant medication ( Volkow and Swanson, 2008 ). These two studies support the safety of stimulant usage for ADHD in children and adolescents and are a state-of-the-art example of translational research from animal to human studies that address an important public health issue (ie, the exposure of a large percentage of children and adolescents to a medication that is assumed but not proven to have long-term side effects). The author declares no conflict interest. References Gill KE, Pierre PJ, Daunais J, Bennett AJ, Martelle S, Gage HD, et al. Chronic treatment with extended release methylphenidate does not alter dopamine systems or increase vulnerability for cocaine self-administration: a study in nonhuman primates. Neuropsychopharmacology. Currently, around 4 million children are treated with stimulants each day in the USA ( Zuvekas and Vitiello, 2012 ), which has led to valid concerns over their possible developmental effects, particularly as children and adolescents are being treated with stimulant medications at the time of profound neural, hormonal, and physical changes and usually over relatively long time periods—several years. A chief concern has been the potential adverse effects of stimulant medications to the developing brain, specifically as they relate to dopamine (DA) brain function and the risk for substance use disorder ( Volkow and Swanson, 2008 ). Similar findings were reported by Soto et al (2012) when peri-adolescent male monkeys were treated with either MPH, AMP, or placebo for 18 months and failed to show effects of stimulant treatment on synaptic DA markers in brain (transporters and D2/D3 receptors; they also failed to see changes in AMP-induced DA increases) as well as in physical growth, both when Therefore, the results of both articles suggest that chronic MPH or AMP started in peri-adolescence/adolescence at clinically relevant doses do not significantly alter DA system development nor do they affect physical growth in non-human primates. They also suggest that they do not sensitize the brain to drug rewards ( Gill et al , 2012 ) nor that they negatively affect cognitive or motor behaviors after discontinuation ( Soto et al , 2012 ). A limitation from these studies is that they are done in healthy animals and the long lasting effects from chronic treatment with stimulant medications may differ in individuals with ADHD. However, the findings, at least as they relate to substance use disorders, are consistent with those from long-term follow-up studies that showed no long-term effects—positive (ie, decreasing risk for substance use) or negative (increasing risk for substance use)—of clinical treatment with stimulant medication ( Volkow and Swanson, 2008 ). These two studies support the safety of stimulant usage for ADHD in children and adolescents and are a state-of-the-art example of translational research from animal to human studies that address an important public health issue (ie, the exposure of a large percentage of children and adolescents to a medication that is assumed but not proven to have long-term side effects). The author declares no conflict interest. 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