Adderall is an effective treatment for attention deficit hyperactivity disorder (ADHD), but a sharp increase in prescriptions in the US over the past two decades has raised concerns among researchers about rare but serious side effects.
In an impressive new study, a team led by psychiatrist Lauren Moran of Mass General Brigham in Boston found that people who take high doses of the stimulant face a more than five times greater risk of developing psychosis or mania.
Among the key factors are the lack of upper dosage guidelines and the notable increase in the number of young adults who
Moran told AFP that her interest grew from the time she worked at a hospital unit that treated students in the metropolitan area of the American city of Boston.
The Food and Drug Administration has added a warning to the drug’s label — but relatively little research has been done to quantify the rates of side effects or how they relate to dose level.
Rare side effects
For their investigation, Moran and colleagues reviewed the electronic health records of people ages 16 to 35 admitted to Mass General Brigham Hospitals between 2005 and 2019. This is the typical age of onset for psychosis, or loss of touch with reality.
Researchers identified 1,374 people experiencing their first episode of psychosis or mania – a disruptive state characterized by high energy, erratic behavior – and compared them to 2,748 control patients who were hospitalized
By looking at Adderall use during the previous month and adjusting for other variables, such as substance use, they were able to specifically determine the impact of stimulants.
They found that those who took Adderall were 2.68 times more likely to be hospitalized with psychosis or mania compared to those who did not – and this rose to 5.28 times more likely at higher doses. large 40 milligrams and above.
A separate analysis found no increased risk with Ritalin, another stimulant prescribed for ADHD. Moran suggested that this could be due to key differences in the two drugs’ mode of action, he writes.
More susceptible to psychosis or mania
Both drugs increase levels of dopamine, a chemical messenger involved in the brain’s reward system, motivation and learning. However, while Adderall, an amphetamine, increases the release of dopamine, Ritalin works by blocking its reabsorption.
For Moran, a key takeaway was the need to clearly state upper dose limits on labels. The current label recommends treating patients with 20 milligrams, but in practice, doctors vary widely in their prescriptions.
This variability is partly due to the impairment requiring higher doses, but Moran has occasionally observed “carelessness in prescribing doses,” while at other times, patients can “buy” a doctor willing to prescribe what they want.
Telemedicine companies, in particular, have come under scrutiny for allegedly overprescribing Adderall, contributing to drug shortages for those who truly need the drug.
