People who take Adderall may be at much higher risk of having a mental breakdown, a study suggests.
People who were prescribed an ADHD medication or other stimulants were 60 percent more likely to experience psychosis or mania than people who did not use those medications.
Stronger doses increased the risk even further: People who took the maximum dose recommended by the FDA had a five-fold increased risk.
Study author Lauren Moran, a researcher at Mass General Brigham, said: “Our results show that it is clear that dose is a risk factor for psychosis and should be a primary consideration when prescribing stimulants.”
Adderall prescriptions have been steadily increasing over the past 12 years. Figures include prescriptions for both brand-name and generic Adderall in the U.S.
Figures suggest that one in eight Americans takes Adderall or other stimulants to treat attention-deficit hyperactivity disorder (ADHD).
The medications are intended to increase concentration and focus. They stimulate the nervous system, increase heart rate and alertness levels, and are similar to the illegal drug ‘speed’.
41 million Adderall prescriptions were dispensed last year
They work by increasing dopamine levels in the brain, which is linked to hallucinations, delusions and paranoia.
The new study looked at around 4,000 people aged 16 to 35.
All patients were admitted to McLean Hospital after being referred from other hospitals in the Mass General Brigham health care system.
The researchers identified 1,374 cases of individuals with a first episode of psychosis or mania, compared with 2,748 control patients with a psychiatric hospitalization for other conditions such as depression or anxiety.
They conducted a comparative analysis of stimulant use over the past month and took into account other factors, including substance use, to isolate the effects of stimulants.
They found that the risk among those exposed to any prescription amphetamine was nearly 63 percent, and for high-dose amphetamine (equivalent to 40 mg of Adderall) it was 81 percent.
These findings suggest that among people taking prescription amphetamines, eight out of 10 cases of psychosis or mania could have been eliminated if they had not taken the high dose, the researchers said.
While a significant dose-related increase in risk was observed in patients taking high doses of amphetamine, no significant increase in risk was observed with the use of methylphenidate (Ritalin), which is consistent with previous research.
While Adderall is the most common ADHD medication in the U.S., there are other approved medications, including methylphenidate (Ritalin), lisdexamfetamine (Vyvanse), and dexamphetamine (Dexedrine).
While they all have similar effects, they act on the brain in slightly different ways and contain different ingredients.
Moran said the findings should not cause alarm, but should prompt increased caution when prescribing these drugs, especially to those with risk factors for psychosis and mania.
“There is limited evidence that prescription amphetamines are more effective at high doses,” Moran said.
The findings were published in the American Journal of Psychiatry.
‘Physicians should consider other medications that our study found to be less risky, especially if a patient is at high risk for psychosis or mania.’
The federal government relaxed rules on prescribing ADHD medications in March 2020, just as the virus was beginning to spread in the United States, allowing telemedicine companies to distribute the medication online without an in-person consultation.
The goal was to keep people out of hospitals and doctors’ offices, while ensuring access to medicines.
But it inadvertently created a booming market for startups that brazenly advertised their “60-second reviews” and aggressively marketed the drug on social media.
According to estimates, about 41 million Americans now have a prescription for Adderall, a 16 percent increase from before Covid hit. Last year, four million new patients received prescriptions, double the number from the year before.
Millions of these patients are children and young adults. It is estimated that up to 10 percent of school-aged children use these drugs, as well as one-third of university students.
The FDA recommends that doctors not prescribe more than 40 mg of Adderall and other stimulants to patients with ADHD, but there is no upper dose limit on drug labels.