Adderall, a popular treatment for attention deficit hyperactivity disorder (ADHD) in the United States, has raised concerns among researchers about its rare, potentially dangerous side effects, while prescriptions have increased dramatically over the past two decades.
People who take high doses of the stimulant are five times more likely to develop psychosis (loss of contact with reality) or mania (a phase of unusually high energy and erratic behavior), a study published Thursday found.
But there are no clear guidelines on the maximum doses that should be taken, and the number of young people using the drug has increased since the Covid-19 pandemic, mostly as part of telemedicine.
The study was conducted by a team led by psychiatrist Lauren Moran of Mass General Brigham Hospital in Boston. The researcher became interested in this topic early in her career, after noticing that a large number of college students were consulting specialists on this topic.
“We were seeing a large proportion of people without a significant psychiatric history who were having their first episode of psychosis or mania in the context of stimulant use,” the doctor told AFP.
When the FDA learned of these cases in the 2000s, it added a warning to the drug’s label. But little research has been done to determine the rates of side effects or their relationship to dosage.
Moran and her colleagues reviewed medical records of people ages 16 to 35 who were admitted to Mass General Brigham hospitals between 2005 and 2019. This age group is the most prominent age at which people develop psychosis.
The researchers found that 1,374 people had experienced their first episode of psychosis or mania, and compared them with 2,748 patients who had been hospitalized for other psychiatric disorders.
By analyzing Adderall use over the previous month and taking into account other variables such as drug use, they were able to pinpoint the effect of stimulants specifically.
They found that those who took Adderall were 2.68 times more likely to be hospitalized for psychosis or mania than those who did not take it, and that likelihood rose to 5.28 times for those who took higher doses (40 milligrams or more).
Telemedicine
A separate study found no increased risk with Ritalin, another stimulant prescribed to treat ADHD. The difference, Moran says, is because of how the drugs work.
Both increase levels of dopamine, which plays a role in motivation and learning. While Adderall, an amphetamine, increases the release of dopamine, Ritalin works by blocking its reabsorption.
The doctor said the study highlights the need to clearly indicate the maximum doses on labels, which currently recommend treating patients with 20 milligrams, but in practice doctors prescribe widely different doses.
This is partly because more advanced ADHD symptoms require a higher dose, but the researcher has sometimes observed “prescription negligence.”
“People, like some doctors, may think that getting rid of all the symptoms of ADHD is possible, but that’s not realistic,” Moran added.
Telemedicine services have been criticized for overprescribing Adderall, contributing to shortages that could deprive those who really need the treatment.
The DEA proposed to stop allowing Adderall to be prescribed through telemedicine services, but extended that proposal until the end of 2024 due to public outcry.