A new study warns that high doses of Adderall, a commonly prescribed medication for attention deficit hyperactivity disorder (ADHD), can significantly increase the risk of developing serious side effects such as psychosis and mania. The research, led by psychiatrist Lauren Moran at Mass General Brigham in Boston, highlights a more than fivefold increased risk for individuals on high doses of the stimulant.
The study, published Thursday, examines the consequences of increased Adderall use, especially among young adults, a trend accelerated by the rise of telemedicine during the Covid-19 pandemic. Moran’s interest in the issue stemmed from observing an uptick in college students experiencing severe psychiatric episodes linked to high doses of prescription stimulants.
The Food and Drug Administration (FDA) had added a warning to Adderall’s label in the 2000s in response to emerging reports of such side effects, but comprehensive research on the dosage-related risks has been limited. Moran and her team analyzed electronic health records of individuals aged 16 to 35 admitted to Mass General Brigham hospitals from 2005 to 2019, focusing on those with first episodes of psychosis or mania.
The analysis identified 1,374 patients who had experienced psychosis or mania and compared them with 2,748 control patients with other psychiatric conditions. The study found that those who had used Adderall were 2.68 times more likely to be hospitalized for psychosis or mania compared to non-users. This risk increased to 5.28 times for those on doses of 40 milligrams or more.
In contrast, no increased risk was found with Ritalin, another ADHD stimulant, which Moran attributes to the differing mechanisms of the two drugs. Adderall, an amphetamine, boosts dopamine release, whereas Ritalin blocks dopamine reabsorption.
Moran emphasized the need for clear upper dosing limits on Adderall labels, noting that current recommendations suggest 20 milligrams, yet actual prescriptions vary widely. She pointed out issues such as “carelessness in dose prescribing” and patients seeking doctors who will prescribe higher doses.
Telemedicine companies have faced scrutiny for potentially overprescribing Adderall, contributing to shortages. Although the Drug Enforcement Administration (DEA) had proposed revoking telehealth prescriptions for Adderall, it has extended these prescriptions through the end of 2024 in response to public feedback.
