High doses of ADHD medications are linked to psychosis

Current research shows that taking high doses of ADHD medications can significantly increase the risk of developing psychosis or mania.

According to a new study published in the American Journal of Psychiatry, drugs such as Adderall, Vyvanse, and generic amphetamines can cause psychosis and mania in patients if not properly monitored. The link between ADHD and psychosis appears to occur only at high doses, defined as over 30 mg of dextroamphetamine or the equivalent.

Videos from VICE

It is estimated that almost 30% of patients are prescribed sufficiently high doses.

Prescription amphetamines “can flood the brain with dopamine, and when you flood the brain with dopamine, you can potentially cause psychosis,” said Jacob Ballon, a psychiatrist and co-director of the INSPIRE clinic at Stanford Medicine.

Previous research has found similar results. For example, a 2019 study in the New England Journal of Medicine found that amphetamine use was associated with a higher risk of psychosis in young people with ADHD compared to methylphenidate.

The new study is unique because it sheds light on the “dose-response relationship,” in which the risk of psychosis and mania increases with the higher dose.

“The United States is experiencing something of an amphetamine moment,” Will Cronenwett, vice chair of clinical affairs in psychiatry at Northwestern Medicine, told NBC News. “The popularity and use of amphetamines is high and continues to rise.”

Unfortunately, patients taking these medications may experience symptoms of psychosis at high doses.

“We've seen this a lot,” said Lauren Moran, the study's lead author. “We see college students who come to us with no major psychiatric history and are prescribed stimulants suddenly develop psychosis.”

Still, the chances of developing psychosis from ADHD medication are, by and large, relatively low, at about 1 in 1,000 people, according to Cronenwett. But it's important to understand your risks and monitor them with a professional – especially if you have a history of other mental health conditions.

“I would counsel patients who have a personal or family history of serious mental illness, including bipolar disorder with mania or schizophrenia,” Cronenwett said. “If these types of illnesses run in the family tree, these individuals should be very cautious about how much and at what dosage they take of these medications.”