High Doses of ADHD Drugs and Their Link to Psychosis: An In-Depth Analysis

Attention Deficit Hyperactivity Disorder (ADHD) is a condition that affects millions of people worldwide, leading to difficulties in maintaining attention, controlling impulses, and regulating activity levels. One of the most commonly prescribed treatments for ADHD is Adderall, a stimulant medication that has proven effective in managing symptoms. However, recent studies have raised concerns about the potential for serious side effects, particularly when the drug is taken in high doses. These side effects include an increased risk of developing psychosis or mania, conditions characterized by a loss of contact with reality and extreme mood swings, respectively.

A groundbreaking study published in the American Journal of Psychiatry has shed new light on the risks associated with high doses of Adderall. The research, led by psychiatrist Lauren Moran, involved a comprehensive review of electronic health records from a Boston hospital, covering the period from 2005 to 2019. The study focused on individuals aged 16 to 35, the typical onset age range for psychosis. The findings were alarming: those who took Adderall were 2.68 times more likely to be hospitalized for psychosis or mania, and this risk increased to 5.28 times greater for doses of 40 milligrams or above.

The study’s methodology was rigorous, comparing 1,374 individuals experiencing their first episode of psychosis or mania to 2,748 control patients. By analyzing Adderall use and adjusting for other variables, the researchers were able to isolate the impact of the drug. Interestingly, another commonly prescribed stimulant for ADHD, Ritalin, did not show an increased risk of psychosis. This difference may be attributed to the distinct mechanisms by which these drugs affect the brain. Adderall increases dopamine release, while Ritalin blocks its reabsorption, leading to different neurochemical outcomes.

Lauren Moran’s interest in this topic was sparked by her experiences treating college students in Boston, many of whom developed their first episode of psychosis or mania while using prescription stimulants. These patients often had no prior psychiatric history, highlighting the potential for these medications to trigger severe mental health issues in susceptible individuals. The study’s findings underscore the need for clear upper dose limits on Adderall’s label, as current prescribing practices vary widely among doctors. This variability can be influenced by patients seeking out physicians willing to prescribe higher doses, a phenomenon known as ‘doctor shopping.’

The COVID-19 pandemic has further complicated the issue, with a rise in telemedicine providers prescribing Adderall. While telemedicine has made it easier for patients to access care, it has also led to concerns about overprescribing. The Drug Enforcement Administration (DEA) extended the ability to prescribe Adderall through telemedicine until the end of 2024, a decision made in response to public feedback. However, this has also contributed to shortages of the medication for those who genuinely need it, as well as increased scrutiny of telemedicine practices.

The story of Julianna McLeod provides a poignant example of the risks associated with high-dose stimulant medications. Julianna experienced her first psychotic episode while taking Vyvanse, another ADHD medication, after resuming the drug post-pregnancy. She may have accidentally taken more than her prescribed dose, leading to delusions and a sense of euphoria. In her mind, she believed she was a ‘super detective’ uncovering child sex trafficking and also thought someone was drugging her and her baby. Her experience highlights the potential for stimulant medications to cause severe psychological side effects, even in individuals without a prior psychiatric history.

The FDA has added warnings to the labels of stimulant medications like Adderall and Vyvanse about the potential for psychosis and mania. However, these side effects are considered rare and have not been extensively researched. Recovery from these side effects can take months, underscoring the importance of careful monitoring and adherence to prescribed dosages. The recent study suggests that dosage plays a crucial role in the likelihood of experiencing these side effects, with higher doses significantly increasing the risk.

The study also highlights the need for further research on the side effects of stimulant medications. While the connection between amphetamines and psychosis has been known, the dose-response relationship had not been established before. The new findings provide evidence of this relationship and emphasize the importance of following FDA-approved guidelines and consulting with healthcare providers. Takeda Pharmaceuticals, the maker of Vyvanse, has stressed the need for adherence to these guidelines to mitigate risks.

One of the most concerning aspects of the study is the lack of upper dosing guidelines for stimulant medications. Current guidelines recommend targeting the dose to symptom control while avoiding side effects, but they do not specify maximum doses. This gap in the guidelines can lead to variability in prescribing practices and increase the risk of adverse outcomes. The researchers recommend avoiding doses above 30 mg dextroamphetamine equivalents to reduce the risk of psychosis or mania, a recommendation that could help standardize treatment and improve patient safety.

Stephen Faraone, a professor of psychiatry, noted that the US FDA has already warned about the potential for stimulants to cause psychosis. However, he also pointed out that most study participants did not have ADHD, suggesting that the findings may not apply to all individuals with the condition. There is also the possibility of confounding factors, such as patients abusing their stimulants, which could skew the results. Despite these limitations, the study provides valuable insights into the risks associated with high-dose stimulant use and underscores the need for caution in prescribing these medications.

Clinicians should exercise caution when prescribing high doses of amphetamines for ADHD, particularly in younger populations and those with a family history of psychosis. The study’s findings highlight the importance of individualized treatment plans and close monitoring of patients. By adhering to recommended guidelines and considering each patient’s unique circumstances, healthcare providers can help mitigate the risks associated with stimulant medications and ensure safer outcomes for their patients.

In conclusion, the recent study on high doses of ADHD drugs and their link to psychosis underscores the need for careful consideration and adherence to dosing guidelines. While stimulant medications like Adderall and Vyvanse are effective in managing ADHD symptoms, they carry significant risks when taken in high doses. The findings highlight the importance of further research, standardized dosing guidelines, and cautious prescribing practices to ensure the safety and well-being of individuals with ADHD. As the use of these medications continues to rise, particularly in the context of telemedicine, it is crucial to balance the benefits of treatment with the potential for serious side effects.