Medications such as Adderall and Vyvanse are commonly prescribed to patients with ADHD. New research is showing that patients taking these newly prescribed amphetamines are more likely to develop psychosis, which may include hallucinations, paranoia, and delusions, when compared to those who have received a prescription for methylphenidates, such as Ritalin or Concerta.
Prescription amphetamines for cases of ADHD have been steadily increasing, and this poses some concern. Back in 2005, patients had a 50-50 chance of being prescribed Ritalin or Adderall. However, amphetamine prescriptions for Adderall to treat ADHD have been steadily rising. While psychosis only occurs in one in 660 patients – patients should know about the increased risk with amphetamines.
In a new study by the New England Journal of Medicine, researchers examined patients aged 13 to 25 years old, who started taking either amphetamines or methylphenidates from January 1st, 2004 to September 30th, 2015. This study included 221,846 patients. In this group, 110,923 were taking methylphenidate and 110,923 were taking amphetamines [1].
This study focused on new users of the medication. In this group, 106 patients on methylphenidates experienced psychosis, compared to the 237 users experiencing psychosis from amphetamines; this is more than doubled.
It should be noted that many patients who are prescribed ADHD medications, may tolerate them well, and these drugs may even be helpful for their symptoms. This study focused on the increased risk of psychosis for patients who have just begun treatment with a new prescription.
In 2007 the federal agency mandated that ADHD medication be labeled to include a warning for both psychiatric and heart issues. The Food and Drug Administration is aware of the issue of psychosis. The FDA has publicized a risk of psychiatric events such as hearing voices or experiencing mania. Both have which have been documented with ADHD medications [1].
What we need to take away from this; patients need to be informed about their use. These medications may have dangerous side effects. Physicians need to be aware of the risks when prescribing these medications to patients, and those who are taking these amphetamines without a prescription, need to know the risks as a user.
Psychosis may be related to both amphetamine and methylphenidate stimulants. However, this study by the New England Journal of Medicine does define that the risk is more than doubled for those taking amphetamines such as Adderall and Vyvanse.
- Medication Guides https://www.fda.gov/Drugs/DrugSafety/ucm085729.htm
- Psychosis with Methylphenidate or Amphetamine in Patients with ADHD https://www.nejm.org/doi/full/10.1056/NEJMoa1813751
- FDA Drug Safety Communication https://www.fda.gov/Drugs/DrugSafety/ucm277770.htm
- Stimulant ADHD Medications: Methylphenidate and Amphetamines https://www.drugabuse.gov/sites/default/files/drugfacts_stimulantadhd_1.pdf
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