Seema Khaneja MD
Updated on: October 11, 2024 5:38 am GMT
Recent research has unveiled significant risks associated with high doses of ADHD medications, particularly in relation to psychosis. The study, conducted by a team led by psychiatrist Lauren Moran of Mass General Brigham in Boston, indicates that individuals taking high doses of stimulant medications, such as Adderall, face a more than fivefold increase in the risk of developing psychosis or mania. This revelation comes amid a sharp rise in prescriptions for ADHD medications in the United States over the past two decades, raising alarm among healthcare professionals about potential long-term side effects.
Link Between High Doses and Psychosis
The study, published in the American Journal of Psychiatry, highlights the concerning correlation between escalating doses of amphetamines and the likelihood of experiencing psychotic symptoms. Moran’s research focused on patients aged 16 to 35, a demographic identified as having a typical onset of psychosis. By reviewing electronic health records from 2005 to 2019, the research team identified 1,374 individuals who experienced their first episode of psychosis or mania and compared them to a control group of 2,748 patients with other psychiatric conditions.
Moran noted that the findings were particularly significant given the increase in young adults using stimulant medications, exacerbated by the rise of telemedicine. “We were just seeing a lot of people coming in without much of a psychiatric history, developing the first episode of psychosis or mania in the context of using prescription stimulants,” Moran explained.
Study Findings
The research revealed that those who had taken Adderall were 2.68 times more likely to be hospitalized for psychosis or mania compared to those who had not used the medication. As the dosage increased, the risk escalated dramatically, with individuals taking doses of 40 milligrams or more showing a 5.28 times greater risk of these severe side effects.
A distinct analysis found that another commonly prescribed stimulant, Ritalin, did not exhibit the same relationship with psychosis risk. This difference may stem from the unique ways these medications function within the body. While both drugs enhance dopamine levels—a neurotransmitter involved in motivation and mood—Adderall increases dopamine release, whereas Ritalin prevents its reabsorption, potentially leading to different psychological effects.
The Need for Clearer Guidelines
Moran emphasized the necessity for established upper dosing limits for ADHD medications to mitigate the associated risks. The current recommendations suggest treating patients with a maximum of 20 milligrams of Adderall, but prescription practices vary significantly among doctors. Such variability may arise from the severity of ADHD symptoms, prompting some clinicians to prescribe higher doses in hopes of achieving symptom relief.
“There seems to be a carelessness in dose prescribing,” Moran stated. “People, including clinicians, might think they can eliminate all ADHD symptoms, but that’s not a realistic expectation.”
The recent findings also spotlight the role of telemedicine in prescription practices. With the growing number of telehealth providers, scrutiny has increased over the potential for overprescribing medications like Adderall, which has contributed to a shortage for patients who genuinely require the drug. In response to public concerns, the Drug Enforcement Administration initially proposed changing the rules regarding telehealth prescriptions for Adderall but opted to extend the current framework until the end of 2024.
Growing Prescription Trends
The prevalence of stimulant prescriptions has surged across the United States, particularly among adults. According to a recent study published in JAMA Psychiatry, prescription rates for amphetamines rose 30% from 2018 to 2022 among individuals aged 20 to 39, while those aged 40 to 59 saw a 17% increase. This trend speaks to the broader acceptance and reliance on these medications as treatment options for ADHD.
Takeda Pharmaceuticals, the manufacturer of Vyvanse, expressed the importance of adhering to FDA-approved guidelines when prescribing their medications. While Teva Pharmaceuticals, maker of Adderall, did not provide a statement regarding the recent study, the implications of the findings echo a growing concern among healthcare providers regarding the safe and effective use of ADHD medications.
Conclusion
More and more people are asking for ADHD medications, and studies show that taking too much can be risky. Because of this, doctors and patients need to be careful when deciding on treatment. Creating clear guidelines for how much medicine to give and keeping track of prescriptions can help make sure these medications are safe and work well. As we learn more about this topic, it’s important to stay informed about the health effects of these common treatments.
