A new study has found that high doses of stimulants like Adderall can increase the risk of psychosis or mania by more than fivefold.
In recent years, prescriptions for amphetamine stimulants to treat ADHD (attention-deficit/hyperactivity disorder) increased significantly. These medications increase levels of neurotransmitters, which help improve attention span, reduce hyperactivity, and manage impulsive behavior.
Some of the ADHD drugs include Adderall, Vyvanse, and generic amphetamines, such as dextroamphetamine. And while the link between amphetamines and psychosis isn’t new, amphetamines increase levels of dopamine in the brain. The neurotransmitter plays many roles in the body, such as impacting memory, affecting attention, regulating mood, controlling movement, and managing emotions.
According to recent reports in the American Journal of Psychiatry, patients who were hospitalized control subjects had a nearly 63% increased risk of psychosis or mania if they took any prescription amphetamine within the past month. Patients on heavy doses of amphetamines were shown to be at even greater risk of a psychotic episode with an 81% risk. Dose is a factor in psychosis risk, yet stimulant medications don’t put an upper dose limit on their labels.
Prior research established the link between psychosis or mania and amphetamines. However, the latest study shows new details on how dosing may impact risk. The highest risk reported was among people taking 30 milligrams or more of dextroamphetamine. This is the equivalent of 40 milligrams of Adderall.
Medium dosage was linked to a 3.5 times higher risk:
- Adderall: medium dosage is 20 milligrams to 40 milligrams
- Vyvanse: medium dosage is 50 milligrams to 100 milligrams
- dextroamphetamine: 15 milligrams to 30 milligrams
The two types of stimulant medications that are readily prescribed for patients with ADHD are amphetamines and methylphenidates. Those who are prescribed the methylphenidate medications, such as Ritalin and Concerta, were not linked to a higher risk of psychosis or mania. Increased risks are limited to stimulants like Adderall and Vyvanse.
According to an analysis of national insurance claim data, around 6% of patients who take amphetamines are prescribed the highest dosages. About 22% are prescribed the medium dosages. And while the risk of developing psychosis from an amphetamine is rare, around 1 in 1,000, it’s important that people who take high doses are aware of the risks.
In the U.S. alone, stimulant use has skyrocketed in recent years, especially among adults. According to a study published this year in JAMA Psychiatry, prescription rates for amphetamines for attention-deficit hyperactivity disorder (ADHD) rose 30% from 2018 to 2022 in people ages 20 to 39. For those people 40 to 59, rates rose 17%.
When counseling your patients who have a family history of serious mental illness, including bipolar disorder with mania or schizophrenia, be very careful about how much of these stimulant medications they use and the doses.
If one of your patients is on a high dose of an ADHD medication and is concerned about it, they should consider the following steps:
Talk with their prescribing doctor
Talking with their doctor or a mental health professional is the most important step. That way, they can review the current dosage and evaluate the need for any adjustments based on symptoms and any side effects.
Keep a diary of their medications
By documenting any side effects caused by the medication, they’re helping the doctor make informed decisions. It’s also important to note side effects, mood changes, sleep patterns, or other symptoms that show up after having taken the medication.
Assess symptoms
Talk with their healthcare provider to find out if the current dosage effectively manages ADHD symptoms. The doctor may lower the dose or switch them to a different medication that may work better for them.
Check out non-pharmacological treatments
Try natural approaches such as behavioral therapy, counseling, lifestyle changes (diet, exercise, sleep hygiene), along with a long-term plan on how that may improve their ADHD symptoms without having to rely on medication.
Watch for side effects
Report any and all side effects to their healthcare provider. Keep an eye on potential side effects that may include mood swings, anxiety, insomnia, or any other unusual behavior.
Consider a tapering plan
If they need to lower their dose of medication, their healthcare provider might recommend a gradual tapering plan that will help avoid withdrawal symptoms while monitoring how their body reacts.
Talk with family members
If appropriate, they may need to involve family members when discussing medication. Family can provide support and help monitor changes in behavior or mood.
Seek a second opinion
If the treatment plan is significantly concerning, they should seek a second opinion from another healthcare professional.
There are alternative drugs that treat ADHD that do not have the mental health risk, such as methylphenidate (Ritalin). In fact, there is very limited evidence that high doses of prescription amphetamines are more effective. So, consider less risky medications, especially if a patient has a high risk of psychosis or mania.
More articles from the December 2024 issue:
- Phishing Scams
- It’s All in the Packaging
- Whooping Cough on the Rise
- Pill Variations and Non-Adherence
- The Power of Unique Endcaps
- Prescription Flavoring
- Beyond Prescription Dispensing
- ADHD Medications
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