ADHD drug raising risk of psychosis

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. The results of the study were published in the latest issue of the New England Journal of Medicine.

The group of researchers from Harvard Medical School and McLean Hospital, used two major databases to collect health information on 221,486 teenagers and young adults and followed them up from ages of 13 to 25 years. These youngsters were all diagnosed with ADHA and were prescribed a stimulant for the first time between 2004 and 2015. Half of the participants received amphetamines such as Adderall and the rest were prescribed methylphenidates such as Ritalin.

ADHD is a condition which is typically manifested with inattention, hyperactivity, restlessness and impulsive behaviour. It can be severe and may impact day to day living. Stimulant drugs are approved for use in ADHD. The US Food and Drug Administration (FDA) in 2017 added a warning to the label of these drugs that stated, “stimulants may cause treatment-emergent psychotic or manic symptoms in patients with no prior history.” Methylphenidate and amphetamines are first line drugs used in ADHD. This study showed that youngsters are 4 times more likely to be prescribed amphetamines like Adderall in 2015 than in 2004. They were 1.6 times more likely to be prescribed methylphenidates such as Ritalin. “At the beginning of our study, in 2005, a patient had about a 50-50 chance of getting Adderall or Ritalin. There has been a huge increase in Adderall prescriptions over the course of the study to almost four times as many prescriptions for Adderall,” said Dr. Lauren Moran, assistant professor at Harvard Medical School, practicing psychiatrist at McLean Hospital, and lead author of the study.

The team noted that one in every 660 youngsters developed an episode of psychosis within a few months after starting the medication. A total of 343 teenagers and young adults developed an episode of psychosis, they noted. They calculated the risk of psychosis to be 0.21 percent for those who were prescribed amphetamine and 0.1 percent for those who were prescribed methylphenidate.

Dr. Moran, in a statement said, “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.”

Moran explained, “There are subtle differences in the way Adderall and Ritalin affect dopamine systems in the brain.” She added that both drugs affected dopamine release in the brain. Adderall is more likely to cause dopamine release and Ritalin works by preventing re-uptake of dopamine making it stay in the brain longer. Moran said that the shart rise in dopamine is associated with the psychotic attacks.

Moran adds that the study looked at young persons using the drugs for the first time and not at those who have been using them for some time. “We’re trying to raise awareness,” she said. “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.”

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1813751

Dr. Ananya Mandal

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Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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