Adderall and similar ADHD medications may raise the risk of experiencing psychosis
As attention deficit-hyperactivity disorder (ADHD) diagnoses continue to rise, new questions are being asked about the safety of the most common medications used to treat the condition.
The findings of a new study published in the New England Journal of Medicine suggests that amphetamines, such as the frequently prescribed Adderall, may contribute to a significantly higher risk of developing psychosis compared to other drugs for ADHD such as methylphenidate stimulants like Ritalin.
The findings come from a large scale assessment of insurance claim data which included information from 221,486 individuals between the ages of 13 to 25 who were first prescribed a stimulant for ADHD between 2004 and 2015.
Approximately half of those included in the data were prescribed amphetamines like Adderall, while the other half were given methylphenidates like Ritalin.
Of those who were followed for the study, a total of 343 teens and young adults developed an episode of psychosis within a few months of being prescribed a stimulant.
While episodes of psychosis were rare for individuals on both types of medications, those given amphetamines were still more than twice as likely to experience psychosis compared to those on methylphenidates (0.21% vs. 0.1%).
“We’ve seen cases of people coming in without much of a psychiatric history who are developing this sort of first episode of psychosis in the setting of stimulant use, most commonly Adderall,” said Dr. Lauren Moran, assistant professor at Harvard Medical School, practicing psychiatrist at McLean Hospital, and lead author of the study.
In fact, it was her experiences and observations treating young individuals with psychosis which inspired the study.
Under the current guidelines, both classes of medicine are recommended for the treatment of ADHD. However, prescription rates for amphetamines had quadrupled among teens and young adults with ADHD between 2004 and 2015. In the same time span, prescription rates for methylphenidates were only 1.6 times higher.
While the public tends to view these medications as interchangeable, “there are subtle differences in the way Adderall and Ritalin affect dopamine systems in the brain,” says Moran.
Adderall tends to trigger the release of dopamine, while Ritalin blocks the reuptake of dopamine which allows it to linger in the system.
The release of dopamine from amphetamines closely resembles the flood of dopamine during a psychotic episode, which may explain some of the findings, according to Moran.
Although the findings raise concern about the risk for psychotic episodes when taking amphetamines for ADHD, it is important to understand how low the overall risk is. Additionally, Moran notes that the risk for those who have been on the medications for a sustained time and have been taking them as prescribed is likely even lower.