People who take Adderall may be at a much greater risk of having a mental breakdown, a study suggests.
Those with a prescription for the ADHD drug or other stimulants were over 60 percent more likely to suffer psychosis or mania than people not using the meds.
Stronger doses raised the risk further – people who took the max dose recommended by the FDA were at a fivefold higher risk.
Study author Lauren Moran, a researcher at Mass General Brigham, said: ‘Our results show that it is clear that dose is a factor in psychosis risk and should be a chief consideration when prescribing stimulants.’
Adderall prescriptions have steadily increased over the last 12 years. The figures include prescriptions for both Adderall, brand and generic, in the U.S.
Figures suggest one in eight Americans take Adderall or other stimulants to treat attention Hyperactivity Deficit Disorder (ADHD).
The drugs are intended to boost concentration and focus by stimulating the nervous system, increase the heart rate and levels of alertness and are similar to the illegal drug ‘speed’.
41 million prescriptions for Adderall were filled last year
They work by ramping up dopamine levels in the brain, which is linked to hallucinations, delusions, and paranoia.
The new study looked at around 4,000 people between the ages of 16 and 35.
All patients were admitted to McLean Hospital following referrals from other hospitals in the Mass General Brigham healthcare system.
The researchers identified 1,374 cases of individuals with first-episode psychosis or mania, compared to 2,748 control patients with a psychiatric hospitalization for other conditions like depression or anxiety.
They conducted a comparison analysis of stimulant use over the preceding month and accounted for other factors, including substance use, in order to isolate the effects of stimulants.
They found the risk among those exposed to any prescription amphetamine was nearly 63% and for high dose amphetamine (equivalent of 40mg of Adderall) was 81 percent.
These findings suggest that among people who take prescription amphetamine, eight in 10 cases of psychosis or mania could have been eliminated if they were not on the high dose, the researchers said.
While a significant dose-related risk increase was seen in patients taking high doses of amphetamine, no significant risk increase was seen with methylphenidate (Ritalin) use, which is consistent with previous research,
While Adderall is the most common drug for ADHD in the US, there are several other licensed medications including methylphenidate (Ritalin), lisdexamfetamine (Vyvanse) and dexamphetamine (Dexedrine).
While they all have similar effects, they work on the brain in slightly different ways and contain different ingredients.
Moran said the findings need not create alarm but should lead to extra caution when these medications are prescribed, especially for those who have risk factors for psychosis and mania.
‘There’s limited evidence that prescription amphetamines are more effective in high doses,’ said Moran.
The findings were published in the American Journal of Psychiatry.
‘Physicians should consider other medications our study found to be less risky, especially if a patient is at high risk for psychosis or mania.’
The Federal Government relaxed rules around prescribing ADHD medicines in March 2020, just as the virus started to take off in the US, allowing telemedicine companies to dish out the drug online without an in-person consultation.
The aim was to keep people out of hospitals and doctors’ clinics, while ensuring access to medicines.
But it inadvertently created a booming market for start-ups who brazenly advertised their ’60-second assessments’ and aggressively marketed the medication on social media.
Today, some 41million Americans have a prescription for Adderall, estimates suggest, a 16 percent surge from before Covid struck. Four million new patients got prescriptions last year, double the previous year.
Millions of these patients are children and young adults. Up to 10 percent of school children are estimated to be on the drugs, as well as a third of college students.
The FDA recommends doctors do not prescribe more than 40mg of Adderall and other stimulants to ADHD patients but there is no upper dose limit on the drugs’ labels.