Research indicates that individuals hospitalized after using high doses of ADHD medications are five times more likely to experience conditions such as psychosis and mania compared to those who do not use the drugs.

A study involving over 1,300 patients at Mass General Brigham hospitals found that the risk of encountering psychosis or mania is significantly linked to the amount of prescription stimulants consumed. These medications, which are commonly prescribed to enhance focus in educational or occupational settings, revealed that patients consuming 30 mg or more of dextroamphetamine, or 40 mg of Adderall, experienced these mental health issues approximately 5.3 times more frequently than those not taking them, according to research published on Thursday in the American Journal of Psychiatry.

Interestingly, the study did not find a similar association with another widely used ADHD medication, methylphenidate, commonly known as Ritalin.

Previous studies indicated that incidences of psychosis and mania among people using these popular prescription stimulants were below 1%. However, this new research from Mass General Brigham establishes a connection between the strength of the prescription and these uncommon side effects for the first time.

Even though these side effects are rare, lead author Lauren Moran emphasized that healthcare providers prescribing these stimulants for ADHD should consider using lower doses and diligently monitor their patients.

Experts not connected to this study remarked that the findings provide crucial insights for physicians prescribing stimulant medications like Adderall.

Nina Kraguljac, a psychiatry and behavioral health professor at Ohio State University, observed that the study clearly indicates only higher dosages of Adderall and similar stimulants are associated with an increased risk.

Kraguljac suggested that doctors should avoid prescribing more than 30 mg of dextroamphetamine or 40 mg of Adderall to mitigate risks.

“This is certainly a novel finding, highly relevant to clinical practice, and reassuring because it indicates that using lower to medium doses does not necessarily heighten the risk of psychosis,” remarked Kraguljac.

Elevated doses carry increased risks

The impetus for the study arose from clinicians observing some patients who developed psychosis and mania after taking prescription amphetamines, according to Moran, who is a psychiatrist and a pharmacoepidemiology researcher at McLean Hospital in Belmont, Massachusetts.

Moran aimed to explore the potential connection between the use of stimulants and specific mental health complications.

The research team analyzed medical histories of patients admitted to McLean between 2005 and 2019 after initial visits to emergency rooms at other Mass General Brigham facilities in the Boston area. The participants were aged 16 to 35.

The study reviewed the cases of 1,374 patients hospitalized due to psychosis or mania as well as 2,748 patients hospitalized for depression, anxiety, or other reasons. Notably, those prescribed amphetamines in the month prior were more frequently diagnosed with psychosis or mania than individuals not on these medications. The strongest doses were linked to the highest likelihood of these mental health issues, and hospital personnel confirmed patients’ prescribed medications and dosages at the time of their admission by checking with pharmacies.

The study focused on three categories of prescription amphetamines: mixed amphetamines like Adderall and Mydayis, dextroamphetamine, and lisdexamfetamine, marketed as Vyvanse. A majority of the participants using amphetamines were prescribed Adderall, noted Moran.

ADHD medications not associated with psychosis or mania

The researchers also looked into the records of patients taking methylphenidate and found no increased risk for psychosis or mania in this group. Methylphenidate is available under brand names like Ritalin and Concerta.

Even among Adderall users or those using other amphetamines, occurrences of psychosis and mania remain uncommon. Previous research demonstrated that these side effects occurred in less than 1% of cases involving prescription amphetamines. Nevertheless, Moran advised caution when healthcare providers prescribe higher dosages of these medications.

Moran’s team is also conducting a nationwide study tracking patients prescribed stimulants for ADHD, analyzing those on low, medium, and high doses, with a focus on comparing rates of psychosis among different dosage levels.

Risks of switching ADHD medications amid shortages

Kraguljac from Ohio State University mentioned that Adderall is typically the first recommended treatment for ADHD. In cases where patients experience side effects, some doctors might opt for Ritalin as a substitute.

However, due to a nationwide shortage of ADHD medications over the past two years, some doctors have begun switching medications for their patients. This shortage has made it necessary for patients to find alternatives or pay more for brand-name medications. The Drug Enforcement Administration recently announced that it would permit manufacturers to ramp up production of Vyvanse.

Kraguljac added that the insights from this study regarding the potential risks posed by higher doses of prescription amphetamines will be valuable for doctors transitioning their patients to new medications.

“Understanding that a higher dose of Adderall can increase risk may be crucial for patient safety, leading to more careful dosing,” Kraguljac stated.