Here we have an introduction of psychoactive chemicals (chemicals that find their way into the brain, and modify one’s mental state).

  1. Types of recreational drugs
  2. Abusable psychiatric drugs
    1. Marijuana
    2. Opioids
    3. Hallucinogens
    4. Minor tranquilizers
    5. Amphetamine-based and methylphenidate-based stimulants
    6. Hypnotics (sleeping drugs)
  3. Other psychiatric medications
    1. Neuroleptics
    2. Antidepressants
    3. Mood-stabilizers
    4. Non-stimulant ADHD drugs
    5. Non-benzodiazepine anti-anxiety drugs

There is overlap. For example, stimulants are listed twice. Some stimulants are absolutely illegal (they treat no medical condition), while others are prescribed for narcolepsy and ADHD.

  • Types of recreational drugs
    • Depressants

      • Examples: methaqualone (quaaludes) and gamma-hydroxy-buryrate (GHB)
    • Stimulants

      • Examples: MDPV and mephedrone
    • Cannabinoids

    • Opioids

      • Examples: heroin and 3-methylfentanyl
  • Watch out: abusable psychiatric drugs

    • Marijuana

      • There’s a lot of debate over whether marijuana is a treatment for mental illness or not.
      • It’s the qualified opinion of this site that THC has extremely limited use in psychiatry.
      • On the other hand, CBD, another cannabinoid of marijuana, has immense promise of treating many forms of mental illness. This why marijuana is included in this section.
      • And so, High-THC and low-CBD marijuana has little potential as a psychiatric drug (though it has its place in physical medicine).
      • High-CBD and very low-THC strains, have much more psychiatric validity.
    • Opioids

      • Now before the outcry, please let me explain myself
      • Firstly, Suboxone (buprenorphine) and Methadose (methadone) are useful in stabilizing, and making functional, opioid addicts, who would otherwise be committing and supporting violent criminal activity. As addiction is mental illness, these are psychiatric medications.
      • Secondly, patients with severely treatment-resistant depression occasionally are given a trial of low-dose Suboxone, buprenorphine the opioid with naloxone, the latter of which prevents abuse
        • A 2015 study found it to be rapidly effective against depression and anxiety
        • As of 2016, buprenorphine combined with a naloxone-like substance has shown positive potential
        • And finally, a 2017 review of all the literature determined that “[buprenorphine] could be of benefit to patients with treatment resistant depression”
      • Thirdly, activation of the δ (delta) opiate receptor, may be useful in fighting a series of psychiatric and neurological disorders, most notably, depression
      • Lastly, drugs directly targeting the opioid system are currently in clinical trials for psychiatric use.
      • This information is absolutely not meant to give an excuse to take opiates for recreation, and/or without the precise instructions of a doctor. Chances are, you’re not going to ever get it prescribed by the psychiatrist.
    • Hallucinogens

      • Ironically enough, whereas some potent opiates and very powerful stimulants are available for psychiatric use today, hallucinogens are not.
      • In the late 1960’s, the United States Government all but halted the research of hallucinogens by making them as illegal as heroin. That’s not to say that hallucinogens can’t be dangerous chemicals, just that careful use under medical care is much less risky.
      • Recently, research has started up again on a few hallucinogens.
      • Psychedelic hallucinogens all activate a particular area on the serotonin receptor (2a)
      • Some hallucinogenic drugs are related to both the trace amine phenylethylamine (PEA), and to psychedelic hallucinogens
        • MDMA, MDA, and associated chemicals
          • This site maintains such chemicals are neurotoxic, neurotoxic, neurotoxic, neurotoxic
            • For instance, long-term use of MDMA is considered to be four days
            • It’s not uncommon to find tons of anecdotes on the internet on how consuming it “long-term” and/or binging on it with a few grams in the space of even months, has led to longstanding or permanent psychiatric complications
      • Dissociative hallucinogens prevent activation of a receptor that glutamte usually binds to (NMDA)
        • In this category, ketamine, at sub-hallucinogenic doses, will probably be available for treatment-resistant depression by 2018
      • The main active compound in the hallucinogn salvia, is of tis own class, activating a non-euphoric region of the opiate receptor, ϰ (kappa)
      • Marijuana tobacco, and ethanol, though all somewhat hallucinogenic at high doses, are not considered hallucinogens
    • Minor tranquilizers

      • Most used today are benzodiazepines.
      • Very useful for short-term anxiety.
      • Long-term use of a chemical in this class, more than four weeks, is abuse insofar as a withdrawal is usually felt.
      • Using benzodiazepines for recreation is particularly dangerous, as withdrawal can be deadly, and is otherwise generally believed to have the most uncomfortable withdrawal.
    • Amphetamine-based and methylphenidate-based stimulants

      • I’ve never been more addicted to another.
      • People who love thinking tend to like these drugs, and finagle unneeded prescriptions for them.
      • The withdrawal is not deadly, or very physical. It might not lead to sleepless nights, or intense anxiety, but it is very real.
      • Life becomes quite bleak for a long time.
    • Hypnotics (substances used to sleep)

      • These drugs are usually either benzodiazepines, or target the benzodiazepine site that deals with sleep.
      • Abusing these drugs prevents a healthy amount, or even any, restful sleep after use is stopped.
      • Lack of sleep is a verified form of torture.
  • Other psychiatric medications

    • Neuroleptics, or, antipsychotics, or, major tranquilizers (for psychotic and bipolar illnesses)

      • Typical
        • Such as Haldol (haloperidol)
          • This one is particularly good for agitation
        • Of an older class
      • Atypical
        • Newer
          • “Atypical” because they also bar the 5-HT2a recpetor from  being activated, which is thought to release more dopamine in the executive, cognitive regions of the brain
        • Such as Abilify (aripiprazole)
        • Supposedly more tolerable
        • Supposedly better at treating negative and cognitive symptoms
      • Full benefits for schizophrenics can take up to six months
        • Psychotic symptoms decrease early on, but these drugs can take several months to optimally decrease negative and cognitive symptoms
    • Antidepressants (for clinical depression)

      • SSRI: selective serotonin reuptake inhibitor
        • Such as Prozac (fluoxetine)
          • The first one
        • Luvox
        • Prozac
        • Zoloft
        • Paxil
        • Lexapro
        • Celexa
      • SNRI: serotonin-norepinephrine reuptake inhibitor
        • Such as Effexor (venlafaxine)
        • Three on the market
      • NDRI: norepinephrine-dopamine reuptake inhibitor, Wellbutrin (bupropion)
        • Has atypical effects, unlike structurally related compounds
      • MAOI (only when several other drugs don’t work): monoamine oxidase inhibitor
        • Must follow a diet while on one
          • Emsam (selegiline) patch requires no diet at 6mg dose
        • Parnate (tranylcypromine)
        • Nardil (phenelzine)
      • Atypical
        • Oleptro (trazodone)
        • Trintellix
        • Remeron (mirtazapine)
      • Tricyclics
        • Many mechanisms, some minor
        • SNRI antidepressant action
          • Some more so work on serotonin
          • Some more so work on norepinephrine (noradrenaline)
    • Mood stabilizers (for bipolar illnesses)

      • Such as Lithobid (lithium)
        • The golden standard of mood stabilizers
      • Some, such as Depakote (valproic acid) work more on mania
      • Lamictal (lamotrigine) is thought to work more on depression
      • Anti-epileptics oftentimes double as mood-stabilizers
      • Wellbutrin is thought to be the least likely antidepressant to induce mania
        • Hence, its use in bipolar depression
    • Non-stimulants used for ADHD

      • Not as effective, but much more safe, than stimulants
      • Straterra (atomoxetine)
        • An NRI
      • Kapvay (clonidine)
      • Intuniv (guanfacine)
      • Off-label medications
        • Wellbutrin
          • Also given to help smokers quit
        • Provigil
        • Nuvigil
          • Essentially, a more potent Provigil
        •  Effexor
          • Also has use in anxiety and depression
    • Non-benzodiazepines used for anxiety (anxiolytics)

      • Buspirone (buspar)
        • Takes a few weeks to work
        • Has several mechanisms
        • Does not carry high risk for dependence as benzodiazepines do
      • Antihistamines
        • Such as Vistaril (hydroxizine)
      • Beta blockers
        • Such as Inderal (propranolol)
      • SSRIs
        • There are many
          • Luvox
          • Prozac
          • Zoloft
          • Paxil
          • Lexapro
          • Celexa
      • SNRIs
        • Venlafaxine
        • Desvenlafaxine
        • Duloxetine
      • Antipsychotics

Sources: Dr. Kevin Davis, Dr. Theodore Papperman, Stahl’s Essential Psychopharmacology, Ben Komor, http://www.healthline.com, https://www.dea.gov, http://www.fda.gov, http://americanaddictioncenters.org, Dr. John Bezirganian, www.psychiatrist.com/jpg/article, http://www.asianjournalofpsychiatry.com/article/S1876-2018(16)30273-8/abstract