Amphetamine ADHD treatment increases psychosis risk

Henrietta Strickland
March 24, 2019

A new study has found that teenagers and youngsters who are treated with amphetamines such as Adderall are at a greater risk of developing psychosis compared to patients who are on other drugs such as Ritalin.

Soon after receiving a stimulant prescription, about one in 660 teens and young adults developed psychotic symptoms, such as hallucinations and hearing voices, the researchers said.

But the risk was not equal among the different stimulants.

While the overall risk for psychosis was still very low, more than twice the amount of patients in the amphetamine group (0.21 percent) were affected by it, compared to.10 percent of those in the methylphenidate group.

About McLean Hospital McLean Hospital is the largest psychiatric affiliate of Harvard Medical School and has a longstanding history of delivering unmatched psychiatric care, conducting innovative brain research, and providing unparalleled professional and public education. The surge of dopamine during a psychotic episode most closely mimics that seen after stimulant use like Adderall, which may explain some of the findings, Moran added.

Approximately 5 million people in the USA under the age of 25 are prescribed medications for the treatment of ADHD. More than 6 million US children and teens have been diagnosed with the disorder, which is characterized by attention difficulty, hyperactivity, and impulsiveness, according to the Centers for Disease Control and Prevention. Through its three-part mission of clinical care, research, and education, McLean has earned a reputation as a world leader in the field of psychiatry and has consistently been recognized as the best psychiatric hospital in the United States by the global magazine U.S. News & World Report. Food and Drug Administration mandated a warning be placed on the drugs.

As for parents and young adults weighing whether to start a medication, Moran hopes the research will prompt a conversation about risks, benefits and alternatives such as behavioral therapy and non-stimulants.

As part of a big data study, researchers probed 221,846 patients with ADHD, aged 13 to 25, who were prescribed either amphetamines or methylphenidates, between 2004 to 2015.

The results do not actually prove that amphetamines, per se, caused the higher risk of psychosis, Moran said. But, she added, other factors were weighed - including the patients' age and sex, the severity of their ADHD, and any diagnoses of other mental health conditions or substance abuse.

And young people on amphetamines were still at higher risk of psychosis than those on methylphenidates.

Moran said the two groups of stimulants work by different mechanisms - with amphetamines triggering a more potent release of the brain chemical dopamine. "We found that the Adderall-type drugs had an increased risk of psychosis".

Dr. Rahil Jummani is a child and adolescent psychiatrist at NYU Langone, in New York City. "Physicians need to be aware of this when prescribing, and people who are getting these medications from friends in college need to know this is a risk".

However, for patients already using amphetamines to treat ADHD with no side effects, there appears to be no cause for concern.

"This study was done on new users", Moran stressed.

Young people who have been on these medications for some time, and have been taking them as prescribed, have a low risk of psychosis.

"I don't want this study misinterpreted where people want to take their kids off Adderall when it's been helpful and they've been on it for a long time", she added. "Not if they've been using them for a long time and are doing well".

Funded by the National Institutes of Health, under award number K23MH110564, the study analyzed data from commercial insurance claims using the Aetion Evidence Platform™.

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