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= __**Stimulants and Eating Disorders**__ = "Our culture, with its emphasis on thinness, recruits people to do things they shouldn't do." - Dr. Harry Brandt Stimulants produce a wide variety of different kinds of effects by enhancing the activity of the [|central] and [|peripheral nervous systems]. Common effects, which vary depending on the substance in question, may include enhanced [|alertness], [|awareness], [|wakefulness], [|endurance], [|productivity], and [|motivation], increased [|arousal], [|locomotion], [|heart rate], and [|blood pressure], and the perception of a diminished requirement for [|food] and [|sleep]. Many stimulants are also capable of improving mood and relieving anxiety, and some can even induce feelings of [|euphoria]. It should be noted, however, that many of these drugs are also capable of causing anxiety, even the ones that may paradoxically reduce it to a degree at the same time. Stimulants exert their effects through a number of different pharmacological mechanisms, the most prominent of which include facilitation of [|norepinephrine] (noradrenaline) and/or [|dopamine] activity (e.g., via [|monoamine transporter] inhibition or reversal[|[2]]), [|adenosine receptor] [|antagonism], and [|nicotinic acetylcholine receptor] [|agonism].
 * //http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono71-toc~mono71-9~mono71-9-6//
 * =__Major Clinical Issues With Eating Disorders and Stimulant Use__=
 * People with eating disorders may use stimulants to control appetite and to provide energy for exercise.
 * MAO-Is (either irreversible or reversible) are contraindicated in people using amphetamines or MDMA. Deaths have been associated with concurrent use of moclobemide and MDMA.
 * The use of stimulants at any level should be discouraged.
 * CBT can be used to address stimulant use and the eating disorder.
 * In particular, assistance with coping skills may assist with impulsive use of stimulants and bingeing behaviours.

__Effects of Stimulants On Eating Disorders__

 * People with eating disorders may use stimulants to control appetite and to provide energy for exercise(360). Consequently, dependence can develop.
 * High rates of cocaine and amphetamine use have been observed in people with eating disorders(347).
 * Appetite suppression and weight loss have been reported to be the reason for the commencement and continuation of cocaine(340).
 * Severity of bulimia has been shown to correlate with the frequency of MDMA and amphetamine use, with users reporting that ecstasy aids in weight loss(360).

__Interactions between stimulants and therapeutic agents for eating isorders__

 * Stimulant drugs are likely to exacerbate the effects of SSRI and SNRI antidepressants in particular (and vice versa) and may result in serotonin syndrome (Appendix 1)x(127, 179, 180). Patients should be warned of signs of serotonin syndrome and be monitored.
 * MAO-Is (either irreversible or reversible) are contraindicated in people using amphetamines or MDMA. Deaths have been associated with concurrent use of moclobemide and MDMAxxx(181, 182).
 * Fluoxetine, paroxetine and norfluoxetine can inhibit the metabolism of MDMA through inhibition of the CYPs involved in its metabolism and may therefore cause toxicityx.

__Management Approaches to Comorbid Eating Disorders and Stimulant Use__

 * The use of stimulants at any level should be discouraged due to the risk of dependence and, most importantly, the possibility of increased chances of toxicity.
 * CBT can be used to address stimulant use***(49, 183) and the eating disorder****(343, 344). In particular, assistance with coping skills may assist with impulsive use of stimulants and bingeing behaviours.

One factor common to drugs and behaviour that develop into addictions in some individuals is their potential for producing pleasure or at least relief from painful emotional states. However other pleasurable stress reducing behaviours seldom if ever seem to evolve into addiction like behaviour patterns. It may be that these addictive behaviours are able to stimulate the endogenous production of opiates,psycho-stimulants or other analogs of exogeneous substances which have high addiction potential. For example elevated levels of opiods have been reported in studies of anorexia, bulimia and obesity. (Pathological gambling, eating disorders and the psychoactive substance use disorders) Leisure. H Blume, S 1993 Howarth Press