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1 week ago
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People who take Adderall may be at a much greater risk of having a mental breakdown, a study suggests.
Those with a prescription for the ADHD drug or other stimulants were over 60 percent more likely to suffer psychosis or mania than people not using the meds.
Stronger doses raised the risk further - people who took the max dose recommended by the FDA were at a fivefold higher likelihood.
The research looked at two groups of people who had a history of depression, anxiety or other mental health issues that put them at risk of psychosis.
Study author Lauren Moran, a researcher at Mass General Brigham, said: 'Our results show that it is clear that dose is a factor in psychosis risk and should be a chief consideration when prescribing stimulants.'
Adderall prescriptions have steadily increased over the last 12 years. The figures include prescriptions for both Adderall, brand and generic, in the U.S.
Figures suggest one in eight Americans take Adderall or other stimulants to treat attention Hyperactivity Deficit Disorder (ADHD).
The drugs are intended to boost concentration and focus by stimulating the nervous system, increase the heart rate and levels of alertness and are similar to the illegal drug 'speed'.
41 million prescriptions for Adderall were filled last year
They work by ramping up dopamine levels in the brain, which is linked to hallucinations, delusions, and paranoia.
The new study looked at around 4,000 people between the ages of 16 and 35.
All patients were admitted to McLean Hospital following referrals from other hospitals in the Mass General Brigham healthcare system.
The researchers identified 1,374 cases of individuals with first-episode psychosis or mania, compared to 2,748 control patients with a psychiatric hospitalization for other conditions like depression or anxiety.
They conducted a comparison analysis of stimulant use over the preceding month and accounted for other factors, including substance use, in order to isolate the effects of stimulants.
They found the risk among those exposed to any prescription amphetamine was nearly 63% and for high dose amphetamine (equivalent of 40mg of Adderall) was 81 percent.
These findings suggest that among people who take prescription amphetamine, eight in 10 cases of psychosis or mania could have been eliminated if they were not on the high dose, the researchers said.
Mania is typically associated with bipolar disorder, which pushes people to both extremes of the emotional spectrum, from intense highs during manic episodes —marked by an inflated sense of self-worth, elevated mood, excessive energy, aggression, and impulsivity— to deep lows during depressive episodes, characterized by overwhelming sadness, fatigue, hopelessness, and loss of interest in engaging with the world.
Manic episodes don't always indicate bipolar disorder, though. Its symptoms overlap with those of other diagnoses, such as anti-social personality disorder.
ASPD creates pattern of disregard for others, impulsive behavior, deceitfulness, aggression, and a lack of remorse. People who have it may engage in harmful or illegal behaviors including self-harm and suicide.
Adderall has been blamed for the death of Elijah Hanson, who was found dead at 21 on the kitchen floor in Tacoma, Washington. He had a long history of treatment for ASPD, but no formal diagnosis of ADHD.
Elijah Hanson (pictured), 21, died by suicide in June. He had suffered mental health issues for years. His family said that a recent Adderall prescription he obtained through Cerebral played a role in his death
Nevertheless, Mr Hanson went down a route that millions of Americans took during the pandemic - he sought out the drugs via the telehealth platform Cerebral.
The embattled platform has come under fire for doling out prescriptions to people who didn't need them, failing to adequately evaluate patients to ensure that they actually needed it, and for prioritizing profits over patient well-being.
Prior to the pandemic, which forced people to forego in-person healthcare, doctors would have to meet with a patient in-person to write a prescription, but now only a virtual consultation is necessary. That changed during the pandemic.
Mr Hanson received a prescription for the drugs in April, even after a first physician Elijah met on the platform denied him the drugs, citing concerns about his mental state.
He created a new account in April, and was able to secure a prescription for Adderall.
Hanson (pictured) was playing Russian Roulette with a gun kept in the household when he died by suicide. His mother would later find his dead body in her kitchen
His brother said that he new Elijah was taking too much.
Mr Hanson's mother Kelli Rasmussen accused Cerebral of being complicit in her son's death just two months after recieving the prescription.
While a significant dose-related risk increase was seen in patients taking high doses of amphetamine, no significant risk increase was seen with methylphenidate (Ritalin) use, which is consistent with previous research,
While Adderall is the most common drug for ADHD in the US, there are several other licensed medications including methylphenidate (Ritalin), lisdexamfetamine (Vyvanse) and dexamphetamine (Dexedrine).
While they all have similar effects, they work on the brain in slightly different ways and contain different ingredients.
Moran said the findings need not create alarm but should lead to extra caution when these medications are prescribed, especially for those who have risk factors for psychosis and mania.
'There's limited evidence that prescription amphetamines are more effective in high doses,' said Moran.
The findings were published in the American Journal of Psychiatry.
'Physicians should consider other medications our study found to be less risky, especially if a patient is at high risk for psychosis or mania.'
The Federal Government relaxed rules around prescribing ADHD medicines in March 2020, just as the virus started to take off in the US, allowing telemedicine companies to dish out the drug online without an in-person consultation.
The aim was to keep people out of hospitals and doctors' clinics, while ensuring access to medicines.
But it inadvertently created a booming market for start-ups who brazenly advertised their '60-second assessments' and aggressively marketed the medication on social media.
Today, some 41million Americans have a prescription for Adderall, estimates suggest, a 16 percent surge from before Covid struck. Four million new patients got prescriptions last year, double the previous year.
Millions of these patients are children and young adults. Up to 10 percent of school children are estimated to be on the drugs, as well as a third of college students.
The FDA recommends doctors do not prescribe more than 40mg of Adderall and other stimulants to ADHD patients but there is no upper dose limit on the drugs' labels.
English (US)