Most addictive drugs come in two general classes: stimulants and depressants. The most fundamental way in which these two types differ can be inferred by their names. Stimulants stimulate the central nervous system and depressants do the opposite, slowing it and all the parts of the body controlled by the central nervous system down.

Of course, there are many other differences between the two. Due to the prevalence of recreational drug use, it’s important to be familiar with the effects of each type of drug in order to be able to recognize the signs of abuse, addiction, and overdose. Both stimulants and depressants claim lives every year due to overdose and other health problems related to long-term abuse. According to the Centers for Disease Control and Prevention (CDC), there were a total of 47,055 drug overdose deaths in the US in 2014.

In addition to overdose, addiction is a serious problem on both ends of the spectrum, for legal and illicit drugs. Without proper education on these substances, it can be easy to put oneself at risk for developing a substance use disorder and find that one’s life is controlled by a drug. An inability or refusal to stop abusing a drug often results in early death from health complications.

Commonly Used

Stimulants

Stimulants, often called “uppers,” are the kinds of drug that make people feel supercharged with energy and focus, even to the point of feeling invincible. They send the central nervous system into overdrive, increasing heart and breathing rates, suppressing appetite, and causing a spike in blood pressure. Certain stimulants can cause a rush of euphoria, especially if they’re taken via common abuse methods like snorting, smoking, or injection.

The most commonly used and abused stimulants include:

  • Caffeine
  • Nicotine
  • Cocaine/crack cocaine
  • Methamphetamine (meth)
  • MDMA (ecstasy)
  • Adderall
  • Ritalin

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Cocaine vs. Crack

Caffeine and nicotine are, of course, legal and mild stimulants that many people use to get themselves going throughout the day, but they come with their own adverse side effects, especially if the drink or cigarette includes harmful additives. Cocaine, meth, and ecstasy are mainly considered to be “street” drugs that have few legitimate medical uses. Drugs like Adderall and Ritalin are stimulant medications that are mostly used legally to treat medical conditions, but they have been increasingly abused by individuals without a prescription.

Vs.

Depressants

Depressants come in several different categories, including legal and socially approved intoxicants, highly illegal street drugs, and different types of prescription anxiety medications and painkillers. They work by inhibiting the central nervous system, and slowing the heart rate and respiratory and gastrointestinal systems. This results in a feeling of relaxation, peace, and often sleepiness. These drugs can also produce an intense euphoria, particularly if abusing opioids. This makes opioids particularly addictive. In 2014, around 2.5 million Americans had an addiction to one of these painkillers.

Common depressants with abuse potential include:

  • Alcohol
  • Heroin
  • Morphine
  • Vicodin
  • Codeine
  • Fentanyl
  • OxyContin
  • Valium
  • Xanax
  • Amobarbital
  • Phenobarbital

Heroin, morphine, Vicodin, codeine, fentanyl, and OxyContin are all opioid painkillers. Heroin is actually very similar to morphine and essentially turns into morphine in the brain, but it tends to be more potent and, due to the fact that it’s highly illegal, is often cut with other substances. Due to both their pain-relieving and pleasant relaxing effects, prescription opioids are some of the most commonly abused drugs of the modern age. They often end up restricted by governments after years of being overprescribed by doctors, resulting in them saturating black markets or simply being shared by friends and family.

Other prescription depressants include benzodiazepines (Valium and Xanax) and barbiturates (amobarbital and phenobarbital). These medications were prescribed for decades as supposed solutions to stress and anxiety disorders. Barbiturates came first, but it was soon found that these drugs were both highly addictive and had a high potential for overdose. Benzodiazepines were developed as a safer alternative, but they are still both addictive and dangerous.

Common Health Effects

Stimulants

Though stimulants may make individuals feel great temporarily, they typically include negative side effects and result in a “crash” when the drug leaves the system, causing symptoms like fatigue, inability to focus, and depression.

Because stimulants increase heart rate and blood pressure, taking them can be very risky for anyone with heart problems or who already has an increased risk of stroke. They can also cause very unpleasant psychological side effects, especially for those who have an underlying mental illness like anxiety, panic disorders, or issues with paranoia. This is a rather common occurrence, as one-third of all people with a mental illness also engage in substance abuse, according to the National Alliance on Mental Illness. Teeth grinding, tremors, and muscle twitches are common as the brain and body become overly stimulated.

Stimulant overdose deaths are most often caused by sudden heart failure, heart attack, stroke, or hyperthermia – a condition in which the body becomes dangerously overheated. Other symptoms include:

  • Nausea and vomiting
  • Loss of consciousness
  • Pain or tightness of the chest
  • Profuse sweating
  • Chills
  • Racing pulse
  • Irregular breathing
  • Convulsions
  • Limb jerking or rigidity
  • Feeling paralyzed
  • Severe headache
  • Hypertension
  • Panic attacks or extreme anxiety
  • Intense paranoia
  • Extreme agitation
  • Aggression
  • Hypervigilance
  • Hallucinations

In the long-term, continued stimulant abuse can result in a weakening of artery walls or inflammation of the heart muscle as high blood pressure wears them down. Stimulants also restrict blood flow to the gastrointestinal tract, leading to ulcers and tears.

Studies have suggested that long-term stimulant abuse may lead to significant permanent changes in the brain, including a reduction of the white matter that’s responsible for impulse control, stress management, and decision-making. Psychological symptoms related to stimulant abuse may also continue long after an individual quits, especially anxiety and depression. There’s even increasing evidence of a link between stimulants like cocaine and Parkinson’s disease.

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Depressants

Depressants are particularly dangerous when it comes to the potential for overdose, especially since these drugs are often mixed with one another to intensify the euphoric effects. Artificially slowing down the central nervous system always comes with risks as it controls the essential functions of the heart and lungs. An overdose of depressants can cause someone’s breathing to slow to the point that not enough oxygen can reach the brain and other vital organs. This can quickly lead to brain damage, coma, and death.

Depressant overdose symptoms can include:

  • Disorientation
  • Unconsciousness
  • No response to stimuli
  • Floppy arms or legs
  • Bluish lips or fingernails
  • Cold or clammy skin
  • Snoring or gurgling sounds
  • Shallow or no breathing

Overdose deaths from these drugs have claimed many lives and are only increasing, especially from prescription opioids.

Long-term effects of depressants can typically be found around the liver and digestive system. Alcohol in particular is very hard on the liver, and long-term, heavy abuse is closely connected to conditions like fatty liver, alcoholic hepatitis, and liver damage or failure. Apparent brain damage can also be observed in individuals who have been abusing alcohol for many years, and the substance increases the risk of developing several different types of cancer. According to studies, 3.2-3.7 percent of all cancer deaths in the US were the result of alcohol consumption.

In general, depressants cause problems because they slow everything down. An unnaturally slow digestive system can lead to chronic constipation and colon cancer, while an impaired respiratory system leaves individuals at a higher risk for respiratory infections.

Long-term use of depressant medications can also lead to psychological depression and increases the chance of experiencing paradoxical effects like anxiety and panic attacks. Some long-term users have developed chronic fatigue syndrome that lasts even after they’ve gotten clean. Insomnia and sexual dysfunction are also common. At the same time, withdrawal symptoms from certain depressants can be seriously dangerous.

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Signs of Abuse

Stimulants

People who abuse stimulants may start out seeming like they’re in a better place than they were before, with more energy, an increased ability to get work done, and, in the case of some stimulants, a more positive attitude. However, over time, as users develop a tolerance and need higher and higher doses to get the same effect, people around them may begin to notice severe crashes, depression, irritability, and agitation. Excitability can turn to anxiety and paranoia, and as obtaining the drug becomes top priority, responsibilities may begin to fall to the wayside, resulting in an overall diminished effectiveness in work or school.

Physical effects that can be signs of stimulant abuse include weight loss, dental problems from teeth grinding or smoking, and the development of twitches or tics. Insomnia can also become a serious problem as the drug keeps users awake, or they may develop strange sleeping patterns, such as staying up for days at a time followed by sleeping for 24 hours or more.

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Depressants

Depressants abuse can make a person appear lazy. Unlike with stimulants, depressants make a person slow down. Users are more likely to want to sit around and relax or sleep. They may lose interest in formerly loved hobbies, old friends, or even personal hygiene. Many of the symptoms may appear very similar to simple depression. These can include:

  • Poor concentration
  • Slow or slurred speech
  • Frequent drowsiness
  • Impaired coordination
  • Impaired memory
  • Dizziness

Physical signs like a slow or irregular heartbeat and low blood pressure are also hints that the problem is depressant abuse and not depression, as are side effects like constipation, itching of the skin, and difficulty urinating. Heroin in particular may cause sores to appear on a person’s body from constant scratching.

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Similarities

While stimulants and depressants are essentially opposites, all drugs of abuse have certain key similarities. All drugs listed have the potential to be addictive and take over a person’s life, and all require professional treatment if an addiction disorder develops. The human brain will also adjust itself to any of these drugs, producing a tolerance and the emergence of unpleasant withdrawal symptoms if an individual stops taking them all at once. There are both legal and illegal drugs in each class, and the legal ones can be quite beneficial if taken as directed by a medical professional.

Whether an upper or downer, there is no drug that is 100 percent safe to use, and abuse of a drug increases all risks of use. There are many specific drugs not listed here that could fit into either category. Any time people obtain a substance for either medical or recreational use, they should be sure to do research on the class of drug and the symptoms of both overdose and addiction to avoid potentially catastrophic health effects.