High Adderall dosage linked to psychosis and mania

According to one study, hospitalized patients taking high doses of prescription amphetamines for ADHD were five times more likely to develop psychosis or mania than patients who did not take the drug.

The study of more than 1,300 patients at Mass General Brigham Hospital linked the risk of psychosis or mania to the dosage of prescription stimulants, drugs used to aid concentration at school or work. Patients who took 30 milligrams or more of dextroamphetamine or 40 milligrams of Adderall were nearly 5.3 times more likely to develop psychosis or mania than those who did not take the drug, according to the study published Thursday in the American Journal of Psychiatry.

The study found no such association for another commonly used ADHD medication, methylphenidate, sold under the brand name Ritalin.

Previous research has shown that psychosis and mania occurred in less than 1% of people taking these commonly used prescription amphetamines, but the Mass General Brigham study is the first to show a link between the strength of the prescription drugs and certain side effects.

Although the drug's side effects are rare, lead study author Lauren Moran said doctors who prescribe these stimulants for attention deficit/hyperactivity disorder “may want to refrain from (higher) doses or just make sure they monitor patients carefully.”

Other researchers not involved in the study said the study provides important information for doctors who prescribe stimulants such as Adderall.

Nina Kraguljac, a professor of psychiatry and mental health at Ohio State University, said the study makes clear that only higher doses of Adderall and other prescription amphetamines are associated with a higher risk.

According to Kraguljac, the study shows that doctors may not want to prescribe more than 30 milligrams of dextroamphetamine or more than 40 milligrams of Adderall.

“This is absolutely novel, very clinically relevant and very helpful because it also ensures that by taking low to moderate doses you do not necessarily increase your risk of psychosis,” Kraguljac said.

Higher doses carry a greater risk

The researchers conducted the study because doctors noticed that some patients with psychosis and mania had also taken prescription amphetamines, said Moran, a psychiatrist and pharmacoepidemiology researcher at McLean Hospital, a psychiatric hospital in Belmont, Massachusetts.

Moran wanted to investigate the possible connection between stimulant use and certain mental illnesses.

Moran's research team collected medical records from patients admitted to McLean between 2005 and 2019 after initially visiting emergency departments at other Mass General Brigham hospitals in the Boston area. The patients ranged in age from 16 to 35.

Researchers examined the medical records of 1,374 patients hospitalized for psychosis or mania, as well as 2,748 patients hospitalized for depression, anxiety, or other reasons. People who had been prescribed amphetamine in the past month were more likely to be diagnosed with psychosis or mania than those who did not take the drug. Those who took the strongest doses were most likely to develop psychosis or mania. Hospital staff contacted patients' pharmacies to document what prescription drugs and doses they were receiving at the time of their hospitalization.

The study looked at three types of prescription amphetamines: mixed prescription amphetamines such as Adderall and Mydayis, dextroamphetamine and lisdexamfetamine, which is sold under the brand name Vyvanse. Most patients prescribed amphetamines took Adderall, Moran said.

Which ADHD medications are not associated with psychosis or mania?

Researchers also examined the medical records of patients taking the ADHD drug methylphenidate and found no increased risk of psychosis or mania. This drug is sold under the brand names Ritalin and Concerta.

Even in people taking Adderall or other prescription amphetamines, the risk is small. Previous research showed that psychosis and mania occurred in less than 1% of patients taking prescription amphetamines. However, Moran said her study suggests that doctors should be cautious when prescribing high doses of prescription amphetamines.

Moran said her research team is conducting a nationwide study of patients prescribed stimulants to treat ADHD. The study will follow participants prescribed low, medium and high doses of ADHD medication. The study will compare rates of psychosis in those taking different doses of the medication.

Given the shortages, there is a risk of switching ADHD medications

Kraguljac, of Ohio State University, said Adderall is generally a “first-line treatment” for patients with ADHD. Some doctors prescribe Ritalin if patients experience side effects from taking Adderall.

High Adderall dosage linked to psychosis and mania

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