Euphoria Explained

Euphoria is the experience (or affect) of pleasure or excitement and intense feelings of well-being and happiness.[1] [2] Certain natural rewards and social activities, such as aerobic exercise, laughter, listening to or making music and dancing, can induce a state of euphoria.[3] [4] Euphoria is also a symptom of certain neurological or neuropsychiatric disorders, such as mania. Romantic love and components of the human sexual response cycle are also associated with the induction of euphoria.[5] [6] [7] Certain drugs, many of which are addictive, can cause euphoria, which at least partially motivates their recreational use.[8]

Hedonic hotspots – i.e., the pleasure centers of the brain – are functionally linked. Activation of one hotspot results in the recruitment of the others. Inhibition of one hotspot results in the blunting of the effects of activating another hotspot. Therefore, the simultaneous activation of every hedonic hotspot within the reward system is believed to be necessary for generating the sensation of an intense euphoria.

History

The word "euphoria" is derived from the Ancient Greek terms Greek, Ancient (to 1453);: εὐφορία: εὖ eu meaning "well" and φέρω pherō meaning "to bear".[9] [10] It is semantically opposite to dysphoria.

A 1706 English dictionary defines euphoria as "the well bearing of the Operation of a Medicine, i.e., when the patient finds himself eas'd or reliev'd by it".[11]

During the 1860s, the English physician Thomas Laycock described euphoria as the feeling of bodily well-being and hopefulness; he noted its misplaced presentation in the final stage of some terminal illnesses and attributed such euphoria to neurological dysfunction.[12] Sigmund Freud's 1884 monograph Über Coca described (his own) consumption of cocaine producing "the normal euphoria of a healthy person",[13] while about 1890 the German neuropsychiatrist Carl Wernicke lectured about the "abnormal euphoria" in patients with mania.[14]

A 1903 article in The Boston Daily Globe refers to euphoria as "pleasant excitement" and "the sense of ease and well-being".[15] In 1920 Popular Science magazine described euphoria as "a high sounding name" meaning "feeling fit": normally making life worth living, motivating drug use, and ill formed in certain mental illnesses.[16] Robert S. Woodworth's 1921 textbook Psychology: A study of mental life, describes euphoria as an organic state which is the opposite of fatigue, and "means about the same as feeling good."[17]

In 1940, The Journal of Psychology defined euphoria as a "state of general well being ... and pleasantly toned feeling."[18] A decade later, finding ordinary feelings of well being difficult to evaluate, American addiction researcher Harris Isbell redefined euphoria as behavioral changes and objective signs typical of morphine.[19] However, in 1957 British pharmacologist D. A. Cahal did not regard opioid euphoria as medically undesirable but an effect which "enhance[s] the value of a major analgesic."[20] The 1977 edition of A Concise Encyclopaedia of Psychiatry called euphoria "a mood of contentment and well-being," with pathologic associations when used in a psychiatric context. As a sign of cerebral disease, it was described as bland and out of context, representing an inability to experience negative emotion.[21]

In the 21st century, euphoria is generally defined as a state of great happiness, well-being and excitement, which may be normal, or abnormal and inappropriate when associated with psychoactive drugs, manic states, or brain disease or injury.[22]

Neuropsychology

Hedonic hotspots are functionally interrelated neural substrates/structures that (intrinsically or extrinsically) generate the feelings of pleasure. Activation of one hedonic hotspot involves the stimulation of the others. Inhibition of one hedonic hotspot blunts the activation the other ones.[23] [24] Therefore, the simultaneous activation of every hedonic hotspot within the reward system is probably necessary for generating the sensation of euphoria.[25]

Types

Many different types of stimuli can induce euphoria, including psychoactive drugs, natural rewards, and social activities.[26] Affective disorders such as unipolar mania or bipolar disorder can involve euphoria as a symptom.

Music-induced

Euphoria can occur as a result of dancing to music, music-making, and listening to emotionally arousing music.[27] [28] Neuroimaging studies have demonstrated that the reward system plays a central role in mediating music-induced pleasure. Pleasurable emotionally arousing music strongly increases dopamine neurotransmission in the dopaminergic pathways that project to the striatum (i.e., the mesolimbic pathway and nigrostriatal pathway).[29] Approximately 5% of the population experiences a phenomenon termed "musical anhedonia", in which individuals do not experience pleasure from listening to emotionally arousing music despite having the ability to perceive the intended emotion that is conveyed in passages of music.

A clinical study from January 2019 that assessed the effect of a dopamine precursor (levodopa), dopamine antagonist (risperidone), and a placebo on reward responses to music – including the degree of pleasure experienced during musical chills, as measured by changes in electrodermal activity as well as subjective ratings – found that the manipulation of dopamine neurotransmission bidirectionally regulates pleasure cognition (specifically, the hedonic impact of music) in human subjects. This research suggests that increased dopamine neurotransmission acts as a sine qua non condition for pleasurable hedonic reactions to music in humans.[30] [31]

Sex-induced

The various stages of copulation may also be described as inducing euphoria in some people. Various analysts have described either the entire sexual act, the moments leading to orgasm, or the orgasm itself as the pinnacle of human pleasure or euphoria.[32]

Drug-induced

A euphoriant is a type of psychoactive drug which tends to induce euphoria.[33] Most euphoriants are addictive drugs due to their reinforcing properties and ability to activate the brain's reward system.

Psychedelics

Traditional psychedelic drugs, such as LSD and psilocybin are capable of inducing euphoria despite lacking addictive qualities. The Global Drug Survey has revealed that out of 22,000 participant reports, MDMA, LSD, and psilocybin mushrooms were ranked most positively on the Net Pleasure Index of all recreational drugs included in the study.[34]

Stimulants

Dopaminergic stimulants like amphetamine, methamphetamine, cocaine, MDMA, and methylphenidate are euphoriants.[35] Nicotine is a parasympathetic stimulant that acts as a mild euphoriant in some people. Xanthines such as caffeine and theobromine may also be considered mild euphoriants by some.

Chewing areca nut (seeds from the Areca catechu palm) with slaked lime (calcium hydroxide) – a common practice in South- and Southeast Asia – produces stimulant effects and euphoria.[36] [37] [38] The major psychoactive ingredients – arecoline (a muscarinic receptor partial agonist)[39] and arecaidine (a GABA reuptake inhibitor)[40] [41] – are responsible for the euphoric effect.[42] [43]

Depressants

Certain depressants can produce euphoria; some of those drugs in this class include alcohol in moderate doses,[44] [45] (GHB),[46] and ketamine.

Some barbiturates and benzodiazepines may cause euphoria. Euphoriant effects are determined by the drug's speed of onset,[47] increasing dose,[48] and with intravenous administration.[49] Barbiturates more likely to cause euphoria include amobarbital, secobarbital and pentobarbital.[50] [51] Benzodiazepines more likely to cause euphoria are flunitrazepam, alprazolam and clonazepam.[52] [53] Benzodiazepines also tend to enhance opioid-induced euphoria.[54]

Pregabalin induces dose-dependent euphoria. Occurring in a small percentage of individuals at recommended doses, euphoria is increasingly frequent at supratherapeutic doses (or with intravenous- or nasal administration).[55] [56] At doses five times the maximum recommended, intense euphoria is reported.[57] Another GABA analogue, gabapentin, may induce euphoria.[58] Characterized as opioid-like but less intense, it may occur at supratherapeutic doses, or in combination with other drugs, such as opioids or alcohol. Ethosuximide and perampanel can also produce euphoria at therapeutic doses.[59] [60]

Opioids

μ-Opioid receptor agonists are a set of euphoriants that include drugs such as heroin, morphine, codeine, oxycodone, and fentanyl. By contrast, κ-opioid receptor agonists, like the endogenous neuropeptide dynorphin, are known to cause dysphoria, a mood state opposite to euphoria that involves feelings of profound discontent.

Cannabinoidergics

Cannabinoid receptor 1 agonists are a group of euphoriants that includes certain plant-based cannabinoids (e.g., THC from the cannabis plant), endogenous cannabinoids (e.g., anandamide), and synthetic cannabinoids.

Inhalants

Certain gases, like nitrous oxide (N2O, aka "laughing gas"), can induce euphoria when inhaled.[61]

Glucocorticoids

Acute exogenous glucocorticoid administration is known to produce euphoria, but this effect is not observed with long-term exposure.

Fasting–induced

Fasting has been associated with improved mood, well-being, and sometimes euphoria. Various mechanisms have been proposed and possible applications in treating depression considered.[62]

Neuropsychiatric

Mania

Euphoria is also strongly associated with both hypomania and mania, mental states characterized by a pathological heightening of mood, which may be either euphoric or irritable, in addition to other symptoms, such as pressured speech, flight of ideas, and grandiosity.[63] [64]

Although hypomania and mania are syndromes with multiple etiologies (that is, ones that may arise from any number of conditions), they are most commonly seen in bipolar disorder, a psychiatric illness characterized by alternating periods of mania and depression.

Epilepsy

Euphoria may occur during auras of seizures[65] [66] typically originating in the temporal lobe, but affecting the anterior insular cortex. This euphoria is symptomatic of a rare syndrome called ecstatic seizures,[67] [68] often also involving mystical experiences.[69] Euphoria (or more commonly dysphoria) may also occur in periods between epileptic seizures. This condition, interictal dysphoric disorder, is considered an atypical affective disorder.[70] [71] Persons who experience feelings of depression or anxiety between or before seizures occasionally experience euphoria afterwards.[72]

Migraine

Some persons experience euphoria in the prodrome – hours to days before the onset – of a migraine headache.[73] [74] [75] Similarly, a euphoric state occurs in some persons following the migraine episode.

Multiple sclerosis

Euphoria sometimes occurs in persons with multiple sclerosis as the illness progresses. This euphoria is part of a syndrome originally called euphoria sclerotica, which typically includes disinhibition and other symptoms of cognitive and behavioral dysfunction.[76] [77]

Gender euphoria

Gender euphoria is satisfaction or enjoyment felt by a person due to consistency between their gender identity and gendered features associated with a gender different to the sex they were assigned at birth. It is considered to be the positive counterpart of gender dysphoria.[78] Related euphorias have also been recorded in studies of alignments between sexual identity and social recognition such as support in schools for lesbian and gay people, and experiences of intersex variation and their diagnoses such as receiving a diagnosis of congenital adrenal hyperplasia which explained physical differences for example.[79]

See also

Psychological
Pharmacological

Notes and References

  1. Book: https://www.sciencedirect.com/science/article/pii/S0074774215000082. "Addicted to Euphoria": The History, Clinical Presentation, and Management of Party Drug Misuse. Bearn J, O'Brien M. Chapter Ten - "Addicted to Euphoria": The History, Clinical Presentation, and Management of Party Drug Misuse. Int. Rev. Neurobiol.. Academic Press. 2015. 9780128029787. International Review of Neurobiology. 120. 205–33. 10.1016/bs.irn.2015.02.005. 26070759. Eating, drinking, sexual activity and parenting invoke pleasure, an emotion that promotes repetition of these behaviors, are essential for survival. Euphoria, a feeling or state of intense excitement and happiness, is an amplification of pleasure, aspired to one's essential biological needs that are satisfied. People use party drugs as a shortcut to euphoria. Ecstasy (3,4-methylenedioxymethamphetamine), γ-hydroxybutyric acid, and ketamine fall under the umbrella of the term "party drugs," each with differing neuropharmacological and physiological actions.. subscription.
  2. Alcaro A, Panksepp J. 2011. The SEEKING mind: primal neuro-affective substrates for appetitive incentive states and their pathological dynamics in addictions and depression. Neuroscience and Biobehavioral Reviews. 35. 9. 1805–1820. 10.1016/j.neubiorev.2011.03.002. 21396397. subscription. Recent human data have demonstrated that the SEEKING brain circuitry, as predicted, is involved in the emergence of a characteristic appetitive affective state, which may be described as "enthusiastic positive excitement" or "euphoria" (Drevets et al., 2001; Volkow and Swanson, 2003) and that do not resemble any kind of sensory pleasure (Heath, 1996; Panksepp et al., 1985) ... However, in our view, cognitive processes, are only one "slice of the pie", and gamma oscillations may be more globally viewed as the overall emotional–motivational neurodynamics through which the SEEKING disposition is expressed, accompanied by a feeling of excitement/eurphoria (not 'pleasure') that is evolutionarily designed to achieve a diversity of useful outcomes. 6613696.
  3. Web site: Key DSM-IV Mental Status Exam Phrases. dead. https://web.archive.org/web/20131113061611/https://www.gatewaypsychiatric.com/key-dsm-iv-mental-status-exam-phrases. 13 November 2013. 17 February 2014. Gateway Psychiatric Services. Mood and Affect. Content adapted from "Brain Calipers, 2nd Edition, David J. Robinson, MD"..
  4. Cohen EE, Ejsmond-Frey R, Knight N, Dunbar RI. 2010. Rowers' high: behavioural synchrony is correlated with elevated pain thresholds. Biol. Lett.. 6. 1. 106–8. 10.1098/rsbl.2009.0670. 2817271. 19755532. This heightened effect from synchronized activity may explain the sense of euphoria experienced during other social activities (such as laughter, music-making and dancing) that are involved in social bonding in humans and possibly other vertebrates.. free.
  5. Georgiadis JR, Kringelbach ML. July 2012. The human sexual response cycle: brain imaging evidence linking sex to other pleasures. live. Prog. Neurobiol.. 98. 1. 49–81. 10.1016/j.pneurobio.2012.05.004. 22609047. https://web.archive.org/web/20160813081909/http://www.kringelbach.org/papers/PN_Georgiadis2012.pdf. 13 August 2016. 13 November 2016. Strong feelings of pleasure and euphoria, as well as marked alterations in cognitive processing, self-referential thought, and physiological arousal are defining features of sexual consummation, especially during orgasm (Mah and Binik, 2001).. Hedonia. 3793929.
  6. Blum K, Werner T, Carnes S, Carnes P, Bowirrat A, Giordano J, Oscar-Berman M, Gold M . Sex, drugs, and rock 'n' roll: hypothesizing common mesolimbic activation as a function of reward gene polymorphisms . Journal of Psychoactive Drugs . 44 . 1 . 38–55 . March 2012 . 22641964 . 4040958 . 10.1080/02791072.2012.662112. Early-stage romantic love can induce euphoria, is a cross-cultural phenomenon, and is possibly a developed form of a mammalian drive to pursue preferred mates. ... Under normal conditions, it is not surprising that sexual activity is physiologically regulated by the reward circuitry of the brain, specifically by dopaminergic pathways (see Figure 1). Moreover, the early stages of a new, romantic relationship can be a powerful and absorbing experience. Individuals in new romantic relationships report feeling euphoric and energetic. They also become emotionally dependent on, desire closeness with, and have highly focused attention on their partner (Reynaud et al. 2010; Young 2009). Human neuroimaging studies have shown that feelings experienced during the early stages of a romantic relationship are associated with neural activations in several reward-system and affect-processing regions of the brain (Young 2009; Aron et al. 2005; Bartels & Zeki 2000; Mashek, Aron & Fisher 2000)..
  7. Book: Jankowiak. William. Intimacies: Love and Sex Across Cultures. Paladino. Thomas. 2013. Columbia University Press. 9780231508766. Jankowiak. William R.. 13. en. Chapter 1. Desiring Sex, Longing for Love: A Tripartite Conundrum. These emotional states may also be manifested behaviorally as "labile psychophysical responses to the loved person, including exhilaration, euphoria, buoyancy, spiritual feelings, increased energy, sleeplessness, loss of appetite, shyness, awkwardness ... in the presence of the loved person" (Fisher 1998:32). The presence of similar neurological mechanisms and brain patterns may account for the ability to readily identify when someone is romantically involved or erotically excited (Fisher 1998:32; Fisher 1995).. https://books.google.com/books?id=B3ap573MxWwC&pg=PA1. limited. Google Books.
  8. Book: Addiction Medicine: Science and Practice. Roache JD. 2010. Springer Science & Business Media. 9781441903389. Johnson BA. 133. en. Role of the Human Laboratory in the Development of Medications for Alcohol and Drug Dependence. It has been observed that drugs of abuse as diverse as alcohol, barbiturates, opiates, and psychomotor stimulants all share a profile of psychoactive effects characterized as euphoria. It is generally accepted that euphoria is at least a partial explanation why these drugs are abused.. https://books.google.com/books?id=zvbr4Zn9S9MC&pg=PA129. limited. Google Books.
  9. Book: A Greek-English Lexicon. Liddell HG, Scott R. Clarendon Press. Revised and augmented throughout by Sir Henry Stuart Jones, with the assistance of Roderick McKenzie.. 1940. Oxford. Perseus. Tufts University.
  10. Web site: Online Etymology Dictionary . 11 May 2008 . https://web.archive.org/web/20081221185537/http://www.etymonline.com/index.php?search=euphoria&searchmode=none . 21 December 2008 . live .
  11. Book: The new world of words: or, Universal English dictionary.. Kersey J, Phillips E. Printed for J. Phillips. 1706. London. EU. en.
  12. Book: The Medical Times & Gazette. Laycock T. 4 January 1862. John Churchill. London. 1. en. Not unfrequently, indeed, the appearance of the patient is more diagnostic than his feelings. This is the case in some very grave diseases, in which that portion of the nervous system which subserves to the feeling of bodily well-being,—termed, in psychological phrase, euphoria—is morbidly modified as to function..
     • Book: The Medical Times & Gazette. Laycock T. 17 May 1864. John Churchill. London. 500. en. The morbid hopefulness of phthisis, physiologically termed euphoria, is seen more particularly in this class of patients. I have often called attention to it at the bedside, and shown that it ushers in the last stage. It is really a disease of the nervous system of a low type, a sort of insanity, and is of the worst significance..
  13. Book: Über Coca. Freud S. 1884., cited in, NIDA Research Monograph #13 Book: http://digisrv-2.biblio.etc.tu-bs.de:8081/docportal/servlets/MCRFileNodeServlet/DocPortal_derivate_00003764/013.pdf#page=130. NIDA Research Monograph #13. ((Siegel RK)). U.S. Government Printing Office. 1977. ((Petersen RC)), ((Stillman RC)). 130. Chapter VI Cocaine: Recreational Use and Intoxication. The psychic effect (of cocaine) consists of exhilaration and lasting euphoria, which does not differ in any way from the normal euphoria of a healthy person.... One senses an increase of self-control and feels more vigorous and more capable of work; on the other hand, if one works, one misses the heightening of the mental powers which alcohol, tea, or coffee induce. One is simply normal, and soon finds it difficult to believe that one is under the influence of any drug at all..
  14. Book: https://books.google.com/books?id=O1N1CgAAQBAJ&pg=PA216. An Outline of Psychiatry in Clinical Lectures: The Lectures of Carl Wernicke. Miller R, Dennison J. Springer. 2015. 9783319180519. 216. en. Lecture 31. [R]ational judgment of actual ability is lost, and a feeling of increased capacity arises, … it induces feelings of happiness, to the point of abnormal euphoria; but here too, assuming that some degree of psychic ability prevails, self-awareness of the change in personality may be enabled—an autopsychic paraesthesia in the above sense. Consequently, the Affective state of abnormal euphoria which determines the clinical picture often shows up as transitions to autopsychic disarray.. Google books.
  15. News: Paris Doctors Say That Scorching is Like Effects of Drugs. Paris Herald. 1903. reprinted in The Boston Daily Globe, 13 May 1903. p. 6
  16. December 1920. Have You Euphoria?. Popular Science. 97. 6. 79. It takes a doctor to give a high-sounding name to a well known phenomenon. "Euphoria" means "feeling fit." It is as much a physiological fact as scarlet fever.
    Nature makes it worth while to be alive simply through euphoria. The joy of making a good tennis stroke, the delight that a Woodsman gets in the open air, the artist's rhapsody—all are due to euphoria. Why do we drink alcohol—when we can get it or smoke tobacco? To affect euphoria. When a lunatic thinks that he is Napoleon and demands the homage due an emperor; he has euphoria in its worst form.
    Too little is known about euphoria. Since it can be affected by drugs and chemicals, who knows but it may have its seat in some gland?. Google books.
  17. Book: https://archive.org/stream/psychologystudyo00wooduoft#page/118/mode/2up. Psychology, a study of mental life. Woodworth, RS. Henry Holt and Company. 1921. New York. 119–120. Chapter VII: Emotion: Various organic states, and the conscious states that go with them. Something was said before about "organic states", under the general head of tendencies to reaction. Fatigue was an example. Now we could include fatigue under the term, "stirred-up state of the organism"; at least, if not precisely "stirred-up", it is uneasy. It is a deviation from the normal or neutral state. Also, it is often a conscious state, as when we speak of the "tired feeling"; not a purely cognitive state, either not simply a recognition of the fact that we are fatigued but a state of disinclination to work any longer. Though fatigue is thus so much like an emotion that it fits under our definition, it is not called an emotion, but a sensation or complex of sensations....
    Many other organic states are akin to emotion in the same way. The opposite of fatigue, the "warmed-up" condition, brought on by a certain amount of activity after rest, is a case in point. It is a deviation from the average or neutral condition, in the direction of greater readiness for activity. The warmed-up person feels ready for business, full of "ginger" or "pep" in short, full of life. The name "euphoria", which means about the same as "feeling good", is given to this condition. Drowsiness is another of these emotion-like states; but hunger and thirst are as typical examples as any.. 16 April 2017. Internet archive.
  18. Bousfield WA. 1940. The Relation of the Euphoric Attitude to the Quality of Sleep. The Journal of Psychology. 9. 2. 393–401. 10.1080/00223980.1940.9917707. Euphoria is a term aptly denoting the state of general well being, and while it involves a relatively enduring and pleasantly toned feeling, its psychological significance derives primarily from its being a semi-emotional attitude of considerable determining power..
  19. Keats AS, Beecher HK. 1952. Analgesic activity and toxic effects of acetylmethadol isomers in man. The Journal of Pharmacology and Experimental Therapeutics. 105. 2. 210–215. 0022-3565. 14928223. 17 September 2016. [Footnote 3] Since matters of some interest hang upon the definition of 'euphoria', direct enquiry of Dr. Isbell brought the following comment (letter of November 1, 1951). 'I think it would be wise to exercise a certain degree of care in our use of the term "euphoria". We use it here in the sense of a train of effects similar to those seen after the administration of morphine. These effects include changes in behavior and objective signs, such as constriction of the pupil, depression of the respiratory rate and volume, drop in rectal temperature, etc. We do not use it in the sense of "feeling of well-being", as this is something that I have been utterly unable to evaluate.' The present authors prefer to limit the definition of euphoria to 'a sense of well-being'.. https://web.archive.org/web/20160922093443/http://jpet.aspetjournals.org/content/105/2/210.extract. 22 September 2016. live.
     • Isbell H, Vogel VH. 1949. The addiction liability of methadon (amidone, dolophine, 10820) and its use in the treatment of the morphine abstinence syndrome. The American Journal of Psychiatry. 105. 12. 909–914. 10.1176/ajp.105.12.909. 0002-953X. 18127077.
     • Book: Testing for Abuse Liability of Drugs in Humans. Jaffe JH, Jaffe FK. National Institute on Drug Abuse. 1989. Fischman MW, Mello NK. National Institute on Drug Abuse Research Monograph Series. 92. Rockville, MD. 4. Historical Perspectives on the Use of Subjective Effects Measures in Assessing the Abuse Potential of Drugs.
  20. Cahal DA. 1957. Analgesic activity of dipipanone hydrochloride in student volunteers. British Journal of Pharmacology and Chemotherapy. 12. 1. 97–99. 10.1111/j.1476-5381.1957.tb01368.x. 0366-0826. 1509651. 13413158. Not all of these effects can be regarded as undesirable. Drowsiness, euphoria, sleep, and 'detachment,' for instance, are effects which enhance the value of a major analgesic..
  21. Book: A Concise Encyclopaedia of Psychiatry. Leigh D, ((Pare CM)), Marks J. 1977. Springer Science & Business Media. 9789401159135. 152. en. A mood of contentment and wellbeing. Euphoria in psychiatric terms always has a pathological connotation and is often an important early sign of organic cerebral disease. It differs from elation in subtle but important ways. It has no infectious quality and no element of gaiety, for its bland contentment is based on lack of awareness and inability to experience sadness or anxiety rather than on anything positive.
    It may be seen in any condition involving extensive cerebral damage, particularly if the frontal lobes are involved. It occurs sooner or later in senile and arteriosclerotic dementias (q.v.), in disseminated sclerosis and in Huntington's chorea (q.v.) and is often seen also after severe head injury and old-fashioned forms of leucotomy (q.v.). Euphoria is sometimes seen in Addison's disease (q.v.).. Google books.
  22. Web site: definition of euphoria in English. Oxford Dictionaries. 16 December 2016. a feeling or state of intense excitement and happiness. https://web.archive.org/web/20160728064542/http://www.oxforddictionaries.com/us/definition/american_english/euphoria. 28 July 2016. dead.
     • Web site: definition of euphoria. Dictionary.com. 16 December 2016. a state of intense happiness and self-confidence
    (psychology) a feeling of happiness, confidence, or well-being sometimes exaggerated in pathological states as mania. https://web.archive.org/web/20161229171012/http://www.dictionary.com/browse/euphoria. 29 December 2016. live.
     • Book: Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Sadock B, Sadock V. 2009. 9th. 411–412, 923. Refers to a persistent and unrealistic sense of well-being, without the increased mental or motor rate of mania.
    Exaggerated feeling of well-being that is inappropriate to real events. Can occur with drugs such as opiates, amphetamines, and alcohol..
     • Book: Mosby's Medical Dictionary. 2009. 8th. 1. a feeling or state of well-being or elation.
    2. an exaggerated or abnormal sense of physical and emotional well-being not based on reality or truth, disproportionate to its cause, and inappropriate to the situation, as commonly seen in the manic stage of bipolar disorder, some forms of schizophrenia, organic mental disorders, and toxic and drug-induced states. 29 December 2016. https://web.archive.org/web/20170702151838/http://medical-dictionary.thefreedictionary.com/Euphoria. 2 July 2017. live.
  23. Berridge KC, Kringelbach ML. May 2015. Pleasure systems in the brain. Neuron. Review. 86. 3. 646–664. 10.1016/j.neuron.2015.02.018. 4425246. 25950633. free.
  24. Castro. DC. Berridge. KC. 24 October 2017. Opioid and orexin hedonic hotspots in rat orbitofrontal cortex and insula.. Proceedings of the National Academy of Sciences of the United States of America. Research article. 114. 43. E9125–E9134. 10.1073/pnas.1705753114. 5664503. 29073109. 2017PNAS..114E9125C . free.
  25. Kringelbach ML, Berridge KC. 2012. The Joyful Mind. live. Scientific American. 307. 2. 44–45. 2012SciAm.307b..40K. 10.1038/scientificamerican0812-40. 22844850. https://web.archive.org/web/20170329211647/http://lsa.umich.edu/psych/research%26labs/berridge/publications/Kringelbach%20%26%20Berridge%202012%20Joyful%20mind%20Sci%20Am.pdf. 29 March 2017. 17 January 2017. So it makes sense that the real pleasure centers in the brain – those directly responsible for generating pleasurable sensations – turn out to lie within some of the structures previously identified as part of the reward circuit. One of these so-called hedonic hotspots lies in a subregion of the nucleus accumbens called the medial shell. A second is found within the ventral pallidum, a deep-seated structure near the base of the forebrain that receives most of its signals from the nucleus accumbens. ...
    On the other hand, intense euphoria is harder to come by than everyday pleasures. The reason may be that strong enhancement of pleasure – like the chemically induced pleasure bump we produced in lab animals – seems to require activation of the entire network at once. Defection of any single component dampens the high.
    Whether the pleasure circuit – and in particular, the ventral pallidum – works the same way in humans is unclear..
  26. Schultz W. 2015. Neuronal reward and decision signals: from theories to data. 26109341 . 4491543. Physiological Reviews. 95. 3. 853–951. 10.1152/physrev.00023.2014. The feeling of high that is experienced by sports people during running or swimming, the lust evoked by encountering a ready mating partner, a sexual orgasm, the euphoria reported by drug users, and the parental affection to babies constitute different forms (qualities) rather than degrees of pleasure (quantities)..
  27. Salimpoor VN, Benovoy M, Larcher K, Dagher A, Zatorre RJ . Anatomically distinct dopamine release during anticipation and experience of peak emotion to music . Nat. Neurosci. . 14 . 2 . 257–262 . 2011 . 21217764 . 10.1038/nn.2726 . 205433454 . Music, an abstract stimulus, can arouse feelings of euphoria and craving, similar to tangible rewards that involve the striatal dopaminergic system. ... the caudate was more involved during the anticipation and the nucleus accumbens was more involved during the experience of peak emotional responses to music. ... Notably, the anticipation of an abstract reward can result in dopamine release in an anatomical pathway distinct from that associated with the peak pleasure itself. .
  28. Mavridis IN . Music and the nucleus accumbens . Surg Radiol Anat . 37 . 2 . 121–125 . March 2015 . 25102783 . 10.1007/s00276-014-1360-0 . 25768771 . The functional connectivity between brain regions mediating reward, autonomic and cognitive processing provides insight into understanding why listening to music is one of the most rewarding and pleasurable human experiences. Musical stimuli can significantly increase extracellular DA levels in the NA. NA DA and serotonin were found significantly higher in animals exposed to music. Finally, passive listening to unfamiliar although liked music showed activations in the NA. ... Music can arouse feelings of euphoria and craving, similar to tangible rewards that involve the striatal DAergic system [16]. Reward value for music can be coded by activity levels in the NA, whose functional connectivity with auditory and frontal areas increases as a function of increasing musical reward [19]. ... Listening to pleasant music induces a strong response and significant activation of the VTA-mediated interaction of the NA with the hypothalamus, insula and orbitofrontal cortex [1].
    Conclusions
    Listening to music strongly modulates activity in a network of mesolimbic structures involved in reward processing including the NA. Music, acting as a positive pleasant emotion, increases NA DAergic activity. Specifically the NA is more involved during the experience of peak emotional responses to music. Reward value of music can be predicted by increased functional connectivity of auditory cortices, amygdala and ventromedial prefrontal regions with the NA. Further research is needed to improve our understanding of the NA role in the influence of music in our lives..
  29. Zatorre RJ . Musical pleasure and reward: mechanisms and dysfunction . Ann. N. Y. Acad. Sci. . 1337 . 1 . 202–211 . March 2015 . 25773636 . 10.1111/nyas.12677 . Most people derive pleasure from music. Neuroimaging studies show that the reward system of the human brain is central to this experience. Specifically, the dorsal and ventral striatum release dopamine when listening to pleasurable music, and activity in these structures also codes the reward value of musical excerpts. Moreover, the striatum interacts with cortical mechanisms involved in perception and valuation of musical stimuli. ... Development of a questionnaire for music reward experiences has allowed the identification of separable factors associated with musical pleasure, described as music-seeking, emotion-evocation, mood regulation, sensorimotor, and social factors. Applying this questionnaire to a large sample uncovered approximately 5% of the population with low sensitivity to musical reward in the absence of generalized anhedonia or depression. Further study of this group revealed that there are individuals who respond normally both behaviorally and psychophysiologically to rewards other than music (e.g., monetary value) but do not experience pleasure from music despite normal music perception ability and preserved ability to identify intended emotions in musical passages. . 2015NYASA1337..202Z . 22212386 . 19 October 2019 . 19 October 2019 . https://web.archive.org/web/20191019131011/https://zenodo.org/record/3456475 . dead .
  30. Ferreri L, Mas-Herrero E, Zatorre RJ, Ripollés P, Gomez-Andres A, Alicart H, Olivé G, Marco-Pallarés J, Antonijoan RM, Valle M, Riba J, Rodriguez-Fornells A . Dopamine modulates the reward experiences elicited by music . Proceedings of the National Academy of Sciences of the United States of America . January 2019 . 116. 9. 3793–3798. 30670642 . 6397525 . 10.1073/pnas.1811878116 . 2019PNAS..116.3793F . Listening to pleasurable music is often accompanied by measurable bodily reactions such as goose bumps or shivers down the spine, commonly called "chills" or "frissons." ... Overall, our results straightforwardly revealed that pharmacological interventions bidirectionally modulated the reward responses elicited by music. In particular, we found that risperidone impaired participants' ability to experience musical pleasure, whereas levodopa enhanced it. ... Here, in contrast, studying responses to abstract rewards in human subjects, we show that manipulation of dopaminergic transmission affects both the pleasure (i.e., amount of time reporting chills and emotional arousal measured by EDA) and the motivational components of musical reward (money willing to spend). These findings suggest that dopaminergic signaling is a sine qua non condition not only for motivational responses, as has been shown with primary and secondary rewards, but also for hedonic reactions to music. This result supports recent findings showing that dopamine also mediates the perceived pleasantness attained by other types of abstract rewards (37) and challenges previous findings in animal models on primary rewards, such as food (42, 43).. free . Neuroscience News. Dopamine Modulates Reward Experiences Elicited by Music. 24 January 2019. 2019PNAS..116.3793F . Ferreri . Laura . Mas-Herrero . Ernest . Zatorre . Robert J. . Ripollés . Pablo . Gomez-Andres . Alba . Alicart . Helena . Olivé . Guillem . Marco-Pallarés . Josep . Antonijoan . Rosa M. . Valle . Marta . Riba . Jordi . Rodriguez-Fornells . Antoni . 116 . 9 . 3793–3798 . 10.1073/pnas.1811878116 . 30670642 . 6397525 . free .
  31. Goupil L, Aucouturier JJ . Musical pleasure and musical emotions . Proceedings of the National Academy of Sciences of the United States of America . 116 . 9 . 3364–3366 . February 2019 . 30770455 . 6397567 . 10.1073/pnas.1900369116 . 2019PNAS..116.3364G . In a pharmacological study published in PNAS, Ferreri et al. (1) present evidence that enhancing or inhibiting dopamine signaling using levodopa or risperidone modulates the pleasure experienced while listening to music. ... In a final salvo to establish not only the correlational but also the causal implication of dopamine in musical pleasure, the authors have turned to directly manipulating dopaminergic signaling in the striatum, first by applying excitatory and inhibitory transcranial magnetic stimulation over their participants' left dorsolateral prefrontal cortex, a region known to modulate striatal function (5), and finally, in the current study, by administrating pharmaceutical agents able to alter dopamine synaptic availability (1), both of which influenced perceived pleasure, physiological measures of arousal, and the monetary value assigned to music in the predicted direction. ... While the question of the musical expression of emotion has a long history of investigation, including in PNAS (6), and the 1990s psychophysiological strand of research had already established that musical pleasure could activate the autonomic nervous system (7), the authors' demonstration of the implication of the reward system in musical emotions was taken as inaugural proof that these were veridical emotions whose study has full legitimacy to inform the neurobiology of our everyday cognitive, social, and affective functions (8). Incidentally, this line of work, culminating in the article by Ferreri et al. (1), has plausibly done more to attract research funding for the field of music sciences than any other in this community.
    The evidence of Ferreri et al. (1) provides the latest support for a compelling neurobiological model in which musical pleasure arises from the interaction of ancient reward/valuation systems (striatal–limbic–paralimbic) with more phylogenetically advanced perception/predictions systems (temporofrontal).. free .
  32. Goldstein A, Hansteen RW . 1977 . Evidence against involvement of endorphins in sexual arousal and orgasm in man . Archives of General Psychiatry . 34 . 10. 1179–1180 . 10.1001/archpsyc.1977.01770220061006. 199128 .
  33. Web site: Merrian-Webster definition . 18 February 2015 . https://web.archive.org/web/20150107231243/http://www.merriam-webster.com/dictionary/euphoriant . 7 January 2015 . live .
  34. Web site: Drug Pleasure Ratings | Global Drug Survey.
  35. Book: Malenka RC, Nestler EJ, Hyman SE . Sydor A, Brown RY . Molecular Neuropharmacology: A Foundation for Clinical Neuroscience . 2009 . McGraw-Hill Medical . New York . 9780071481274 . 191, 350–351, 367–368, 371–375 . 2nd . Changes in appetite and energy may reflect abnormalities in various hypothalamic nuclei. Depressed mood and anhedonia (lack of interest in pleasurable activities) in depressed individuals, and euphoria and increased involvement in goal-directed activities in patients, who experience mania, may reflect opposing abnormalities in the nucleus accumbens, medial prefrontal cortex, amygdala, or other structures. ... Although short-term administration of glucocorticoids often produces euphoria and increased energy, the impact of long-lasting increases in endogenous glucocorticoids produced during depression can involve complex adaptations such as those that occur in Cushing syndrome (Chapter 10). ... Exposure to addictive chemicals not only produces extreme euphoric states that may initially motivate drug use, but also causes equally extreme adaptations in reinforcement mechanisms and motivated behavior that eventually lead to compulsive use. Accordingly, the evolutionary design of human and animal brains that has helped to promote our survival also has made us vulnerable to addiction..
  36. Book: https://books.google.com/books?id=Yu9eBwAAQBAJ&pg=PA791. Neuropathology of Drug Addictions and Substance Misuse Volume 3: General Processes and Mechanisms, Prescription Medications, Caffeine and Areca, Polydrug Misuse, Emerging Addictions and Non-Drug Addictions. Cox S, Ullah M, Zoellner H. Preedy VR. Academic Press. 2016. 9780128006771. 791. en. Oral and Systemic Health Effects of Compulsive Areca Nut Use. The areca nut is the fourth most used drug after nicotine, alcohol, and caffeine. The effects are described as pleasurable and generally stimulating, inducing a sense of well-being, euphoria, heightened alertness, a warm sensation throughout the body, and an increased capacity to work..
  37. June 2014. A review of the systemic adverse effects of areca nut or betel nut. Indian Journal of Medical and Paediatric Oncology. 35. 1. 3–9. It is one of the most widely consumed addictive substances in the world after nicotine, ethanol and caffeine, and is consumed by approximately 10% of the world's population.... The users of areca nut believe that it is helpful for the digestive system and has mild euphoric effects. ...
    The major parasympathetic and muscarinic effects of areca nut are due to arecoline.. Garg A, Chaturvedi P, Gupta PC. 10.4103/0971-5851.133702. 25006276. 4080659 . free .
  38. August 2012. Association of Betel Nut with Carcinogenesis: Revisit with a Clinical Perspective. PLOS ONE. 7. 8. e42759. 10.1371/journal.pone.0042759. 1932-6203. 3418282. 22912735. Sharan RN, Mehrotra R, Choudhury Y, Asotra K. 2012PLoSO...742759S. free.
  39. Book: Veterinary Pharmacology and Therapeutics. Riviere JE, Papich MG. John Wiley & Sons. 2013. 9781118685907. 165. en. Pilocarpine, arecoline and muscarine are rather selective parasympathetic agents; i.e., their cholinomimetic activity is exerted primarily at muscarinic sites with minimal nicotinic effects..
  40. Liu YJ, Peng W, Hu MB, Xu M, Wu CJ. November 2016. The pharmacology, toxicology and potential applications of arecoline: a review. Pharmaceutical Biology. 54. 11. 2753–2760. 10.3109/13880209.2016.1160251. 1744-5116. 27046150. free.
  41. Peng W, Liu YJ, Wu N, Sun T, He XY, Gao YX, Wu CJ. April 2015. Areca catechu L. (Arecaceae): a review of its traditional uses, botany, phytochemistry, pharmacology and toxicology. Journal of Ethnopharmacology. 164. 340–56. 10.1016/j.jep.2015.02.010. 1872-7573. 25681543. Previous investigations indicated that the arecaidine and guvacine isolated from the A. catechu are effective antagonists of GABA, with IC50 values 122712 μM and 871 μM, respectively (Johnston et al., 1975; Lodge et al., 1977)..
  42. Book: Manual of Drug and Alcohol Abuse: Guidelines for Teaching in Medical and Health Institutions. Arif A, Westermeyer J. Springer Science & Business Media. 2012. 9781461595168. New York. 159–160. en.
  43. Book: Aronson, J. K.. Meyler's Side Effects of Herbal Medicines. Elsevier. 2009. 9780444532695. 53. en. The lime in the betel quid [areca nut, lime and ''Piper betle'' leaves] causes hydrolysis of arecoline to arecailide, a central nervous stimulant, which accounts, together with the essential oil of the betel pepper, for the eucphoric effects of chewing betel quid..
  44. Gilman JM, Ramchandani VA, Davis MB, Bjork JM, Hommer DW . Why we like to drink: a functional magnetic resonance imaging study of the rewarding and anxiolytic effects of alcohol . J. Neurosci. . 28 . 18 . 4583–4591 . 2008 . 18448634 . 2730732 . 10.1523/JNEUROSCI.0086-08.2008 .
  45. Morgan CJ, Badawy AA . 2001 . Alcohol-induced euphoria: exclusion of serotonin . Alcohol and Alcoholism . 36 . 1. 22–25 . 10.1093/alcalc/36.1.22. 11139411 . free .
  46. Busardò FP, Jones AW. 2015. GHB Pharmacology and Toxicology: Acute Intoxication, Concentrations in Blood and Urine in Forensic Cases and Treatment of the Withdrawal Syndrome. Current Neuropharmacology. 13. 1. 47–70. 10.2174/1570159X13666141210215423. 1570-159X. 4462042. 26074743.
  47. Book: Clinical Textbook of Addictive Disorders, Fourth Edition. Mack AH, Brady KT, Miller SI, Frances RJ. 2016. Guilford Publications. 9781462521708. 249. en.
  48. Book: Pharmacology: A Patient-Centered Nursing Process Approach. McCuistion LE, Kee JL, Hayes ER. 2014. Elsevier Health Sciences. 9780323293488. 54. en.
  49. Book: Concepts of Chemical Dependency. Doweiko HE. 2014. Cengage Learning. 9781285457178. 79. en.
  50. Book: Determinants of Substance Abuse: Biological, Psychological, and Environmental Factors. Galizio M, Maisto SA. 2013. Springer Science & Business Media. 9781475799903. 205. en.
  51. Book: Psychotropic Agents: Part III: Alcohol and Psychotomimetics, Psychotropic Effects of Central Acting Drugs. 2012. Springer Science & Business Media. 9783642677700. 420. en.
  52. Book: Addictions: A Comprehensive Guidebook. McCrady. Barbara S.. Epstein. Elizabeth E.. 2013. OUP USA. 9780199753666. 163. en.
  53. Book: Lowinson and Ruiz's Substance Abuse: A Comprehensive Textbook. Ruiz P, Strain EC. 2011. Lippincott Williams & Wilkins. 9781605472775. 258. en.
  54. Book: Controlled Substance Management in Chronic Pain: A Balanced Approach. Staats PS, Silverman SM. 2016. Springer. 9783319309644. 77. en.
  55. Web site: Lyrica. 20 August 2016. Drugs.com. https://web.archive.org/web/20170813014258/https://www.drugs.com/pro/lyrica.html. 13 August 2017. live.
  56. January 2016. Abuse Potential of Pregabalin: A Systematic Review. CNS Drugs. 30. 1. 9–25. 10.1007/s40263-015-0303-6. 1179-1934. 26767525. Pregabalin is, in some cases, used for recreational purposes and it has incurred attention among drug abusers for causing euphoric and dissociative effects when taken in doses exceeding normal therapeutic dosages or used by alternative routes of administration, such as nasal insufflation or venous injection.. Schjerning O, Rosenzweig M, Pottegård A, Damkier P, Nielsen J. 3800377. 29 April 2017. https://web.archive.org/web/20170813012537/http://www.antonpottegaard.dk/publications/reviews/Abuse_Potential_of_Pregabalin.pdf. 13 August 2017. live.
  57. Book: https://books.google.com/books?id=Yu9eBwAAQBAJ&pg=PA948. Neuropathology of Drug Addictions and Substance Misuse Volume 3: General Processes and Mechanisms, Prescription Medications, Caffeine and Areca, Polydrug Misuse, Emerging Addictions and Non-Drug Addictions. Martinotti G, Papazisis G, Santacroce R, Kouvelas D, Cinosi E, Lupi M, ((di Giannantonio M)). Academic Press. 2016. 9780128006771. Preedy VR. London. 948–949. en. Pregabalin Abuse and Addiction. Exceeding the therapeutic doses, pregabalin is described as an 'ideal psychotropic drug' for recreational purposes, including alcohol/GHB/benzodiazepine-like effects, euphoria, entactogenic feelings, and dissociation. ...
    Up to 1200mg ... euphoria ... Over 1500mg ... intense euphoria.
  58. Smith RV, Havens JR, Walsh SL. 2016. Gabapentin misuse, abuse, and diversion: A systematic review . Addiction. 111. 7. 1160–1174. 10.1111/add.13324. 5573873. Several case studies mentioned experiencing euphoria after gabapentin misuse that was reminiscent of, but not as strong as, opioids. This feeling was achieved in combination with other drugs (e.g., buprenorphine/naloxone, methadone, baclofen, quetiapine, alcohol) as well as by using gabapentin alone, in dosages ranging from 1500–12000 mg, though only three articles give actual amounts misused.. 27265421.
  59. Web site: Ethosuximide. Australian Medicines Handbook. Australian Medicines Handbook Pty Ltd. Rossi, S. Adelaide, Australia. July 2017. 12 August 2017.
  60. Web site: Perampanel. Australian Medicines Handbook. Australian Medicines Handbook Pty Ltd. Rossi, S. Adelaide, Australia. July 2017. 12 August 2017.
  61. Huang C, Johnson N. 2016. Nitrous Oxide, From the Operating Room to the Emergency Department . Current Emergency and Hospital Medicine Reports. 4. 16. 11–18-->. 10.1007/s40138-016-0092-3. 2167-4884. 4819505. 27073749. The term 'laughing gas' is a common layman's term for nitrous oxide, given its ability to create a sense of euphoria in the user. In addition, as noted earlier, it has an opioid-like effect, which accounts for its analgesic properties..
  62. Fond G, Macgregor A, Leboyer M, Michalsen A. 2013. Fasting in mood disorders: neurobiology and effectiveness. A review of the literature. Psychiatry Research. 209. 3. 253–258. 10.1016/j.psychres.2012.12.018. 23332541. 39700065. 14 November 2018. https://web.archive.org/web/20180719195929/http://www.hal.inserm.fr/inserm-00789122/file/PRISMA_FLOW_DIAGRAMM_FASTING_07_12_12.pdf. 19 July 2018. live.
  63. Book: Diagnostic and Statistical Manual of Mental Disorders (DSM-5) . https://books.google.com/books?id=-JivBAAAQBAJ&q=manic+euphoria&pg=PT272 . Bipolar and Related Disorders . 5th . 9780890425572 . American Psychiatric Association . 2013 .
  64. Ruggero CJ, Kotov R, Watson D, Kilmer JN, Perlman G, Liu K . Beyond a single index of mania symptoms: structure and validity of subdimensions . J. Affect. Disord. . 161 . 8–15 . June 2014 . 24751301 . 10.1016/j.jad.2014.02.044 .
  65. Book: https://books.google.com/books?id=e92nFwJ2fMEC&pg=PA248. Behavioral Aspects of Epilepsy: Principles and Practice. Dahl J, Lundgren TL. Demos Medical Publishing. 2007. 9781934559888. Holmes GL, Schachter SC, ((Kasteleijn-Nolst Trenite DGA)). 248. en. Conditioning mechanisms, behavior technology, and contextual behavior therapy. [S]eizures themselves may be stimulating or may induce euphoria. Dostoyevsky describes his seizure experience as follows 'the air was filled with a big noise and I tried to move. I felt the heaven was going down upon the earth and that it had engulfed me. I have really touched God. He came into me myself. Yes, God exists. I cried, and I don't remember anything else. You all, healthy people ... can't imagine the happiness we epileptics feel during the second before our fit ... I don't know if this felicity lasts for seconds, hours, or months but believe me, for all the joys that life may bring, I would not exchange this one'.. [emphasis added]
  66. Book: https://books.google.com/books?id=8kvSfEFQhYwC&pg=PA57. The Neuropsychiatry of Epilepsy. Kanner AM. Cambridge University Press. 2011. 9781139497893. Trimble MR, Schmitz B. 57. en. Peri-ictal psychiatric phenomena. The classic expression of an ictal psychiatric symptom is an "aura," presenting as feelings of fear, sadness, or euphoria..
  67. Gschwind M, Picard F. January 2016. Ecstatic Epileptic Seizures: A Glimpse into the Multiple Roles of the Insula. Frontiers in Behavioral Neuroscience. 10. 21. 10.3389/fnbeh.2016.00021. 4756129. 26924970. free. In a table listing cases of ecstatic seizures reported in the literature, descriptions include: "Euphoric and talkative", "calm euphoria", "Pleasant feeling, euphoria", "Pleasant feeling, and feels euphoria", "short euphoric states"; others are within the definition of euphoria: "Sudden feeling of extreme well-being", "Ineffable joy. Intense pleasure without match in reality (perhaps music)", "Extreme happiness", "intense (non-sexual) pleasure", "Intense happy feeling", "Sudden indescribably pleasant and joyous feeling", "Sensation of intense well-being", "Intense pleasant feeling", "Intense feelings of bliss and well-being".
  68. September 2014. Predictions, perception, and a sense of self. Neurology. 83. 12. 1112–8. 10.1212/WNL.0000000000000798. 0028-3878. 4166359. 25128179. Picard F, Friston K.
  69. May 2008. Spirituality and religion in epilepsy. Epilepsy & Behavior. 12. 4. 636–643. 10.1016/j.yebeh.2007.11.011. 1525-5050. 18171635. Devinsky O, Lai G. 8768458.
  70. Book: https://books.google.com/books?id=AVdmjEr9CGMC&pg=PA777. The American Psychiatric Publishing Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill. American Psychiatric Publishing. 2011. 9781585623792. Levenson JL. 777. en. Neurology and Neurosurgery.
  71. Book: https://books.google.com/books?id=u7ICX2Yh4HoC&pg=PA106. Neuropsychiatric Disorders. Mulu M. Springer Science & Business Media. 2010. 9784431538714. Miyoshi K, Morimura Y, Maeda K. 106–107. en. The Interictal Dsyphoric Disorder of Epilepsy.
  72. Book: Seizures and Epilepsy. Engel J. Oxford University Press. 2013. 9780195328547. 332, 383. en. Patients who are aware of increased depression or tension prior to generalized tonic-clonic or limbic seizures occasionally report a feeling of euphoria or release during the postictal period....
    [P]atients with interictal or preictal depression can report relief or euphoria postictally, which is consistent with the well-known beneficial effect of electroconvulsive shock therapy (ECT). Postictal hypomania can occur, particularly after repeated limbic seizures.. 23 April 2017. https://web.archive.org/web/20170423163853/https://books.google.com/books?id=5PgjmjugIX8C&pg=PA332. 23 April 2017. live.
  73. Book: Migraine. Dodick DW, Silberstein SD. Oxford University Press. 2016. 9780199793693. 3rd. 2, 15. en. More than 70% of migraineurs experience premonitory phenomena hours to days before headache onset. Psychological symptoms include anxiety, depression, euphoria, irritability, restlessness, mental slowness, hyperactivity, fatigue, and drowsiness.
    Following the headache, the patient may have impaired concentration or feel tired, washed out, irritable, and listless. Some people, however, feel unusually refreshed or euphoric after an attack.. [emphasis added]
  74. Book: https://books.google.com/books?id=h-acBAAAQBAJ&pg=PA51. Headache and Migraine Biology and Management. Green MW, Colman R. Academic Press. 2015. 9780128011621. Diamond S. 51. en. 6. Complicated Migraine. [P]remonitory symptoms can occur hours to a day or more prior to a migraine attack (with or without aura). Prodromal symptoms include various combinations of fatigue, stiff neck, sensitivity to light or sounds, difficulty in concentrating, depression or euphoria, cold hands and feet, blurred vision, yawning, nausea and pallor.. [emphasis added]
  75. Book: https://books.google.com/books?id=icdGAAAAQBAJ&pg=PA532. Family Medicine: Principles and Practice. Walling AD. Springer Science & Business Media. 2013. 9780387217444. Taylor RB. 6th. 532. en. 63. Headache. Patients in the 'classic' subgroup (approximately 20% of all migrainers) experience a characteristic aura before the onset of migraine head pain.... A much larger proportion of patients describe prodromal symptoms, which may be visceral, such as diarrhea or nausea, but are more commonly alterations in mood or behavior. Food cravings, mild euphoria (conversely, yawning), and heightened sensory perception, particularly of smell, are surprisingly common....
    The attack often terminates with sleep.... Many patients report a 'hangover' on waking after a migraine, but others report complete freedom from symptoms and a sense of euphoria.. [emphasis added]
  76. Haussleiter IS, Brüne M, Juckel G . Psychopathology in multiple sclerosis: diagnosis, prevalence and treatment . Ther. Adv. Neurol. Disord. . 2 . 1 . 13–29 . January 2009 . 21180640 . 3002616 . 10.1177/1756285608100325 .
  77. Book: https://books.google.com/books?id=vLZfWtLxnucC. Neuropsychiatric Dysfunction in Multiple Sclerosis. Romano S, Nocentini U. 2012. Springer Science & Business Media. 9788847026766. Nocentini U, Caltagirone C, Tedeschi G. en. Euphoria, Pathalogical Laughing and Crying.
  78. Ashley. Florence. Ells. Carolyn. 2018-12-02. In Favor of Covering Ethically Important Cosmetic Surgeries: Facial Feminization Surgery for Transgender People. The American Journal of Bioethics. 18. 12. 23–25. 10.1080/15265161.2018.1531162. 1526-5161. 31159694. 81006262.
  79. Book: Jones, Tiffany . Euphorias in gender, sex and sexuality variations : positive experiences . 2023 . 978-3-031-23756-0 . Cham, Switzerland . 1371240775.

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