Adderall Use Associated with Increased Risk of Psychosis

Peter Simons
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Twice as many teenagers diagnosed with ADHD experienced severe psychosis when taking Adderall, as compared to Ritalin, according to a new study. The article, published in the New England Journal of Medicine, reported that among those taking Adderall (amphetamine), a drug commonly prescribed for children in the US diagnosed with ADHD, 1 in 468 experienced psychosis. Of those taking Ritalin (methylphenidate), 1 in 1,046 experienced psychosis.

According to the researchers, although this risk seems low, it could result in thousands of cases of psychosis, since millions of children are exposed to these drugs. Other studies have shown that children taking Ritalin are twice as likely as those not on the drug to experience hallucinations, so that drug is not without psychosis risk either.

Photo Credit: Pixabay

The current study was led by Lauren V. Moran at Beth Israel and McLean Hospital. The researchers examined data from two different health care claims databases which had coverage across the US. They compared teenagers and young adults (ages 13-25), in the US, who had taken either amphetamines (Adderall) or methylphenidate (Ritalin) for ADHD. The outcome was psychosis severe enough to require a diagnosis and prescription of antipsychotics. People who had already experienced psychotic symptoms were excluded. In total, the study followed 221,846 people, evenly split between those who took Adderall and those who took Ritalin.

Of those taking Ritalin, 106 people (0.10%) experienced psychosis. Of those taking Adderall, 237 people (0.21%) experienced psychosis. The researchers theorized that because of the way amphetamine impacts the brain, it might be associated with higher incidence of psychosis.

“Both methylphenidate and amphetamine induce the release of dopamine from neurons and inhibit the dopamine transporter, which promotes reuptake of dopamine into presynaptic terminals. However, dopamine release is four times as high with amphetamine as with methylphenidate.”

The researchers conducted numerous sensitivity analyses to ensure that confounding factors did not impact their findings, including accounting for substance abuse and other potential factors.

One limitation of this study is that they required both a diagnosis and prescription of antipsychotic medication in order to count the person as having experienced psychosis. If the person experienced less severe psychotic symptoms or was not prescribed medication, they would not count for this survey. Thus, it’s likely that the rate of psychotic symptoms was actually much higher than reported.

Stimulant medications have been associated with high risk of insomnia and appetite suppression. However, they also carry other risks such as hallucinations, cardiac arrhythmia, and death. About 1 in 100 children taking Ritalin experiences what is termed a “serious adverse event.”

The Cochrane Collaboration, which provides independent reviews of studies of the effectiveness of medications, describe the studies on stimulants as being “of very low quality” and at “high risk of bias.”

 

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Moran, L. V., Ongur, D., Hsu, J., Castro, V. M., Perlis, R. H., & Schneeweiss, S. (2019). Psychosis with methylphenidate or amphetamine in patients with ADHD. New England Journal of Medicine, 380, 1128-1138. doi: 10.1056/NEJMoa1813751 (Link)

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Peter Simons
Peter Simons
Peter Simons was an academic researcher in psychology. Now, as a science writer, he tries to provide the layperson with a view into the sometimes inscrutable world of psychiatric research. As an editor for blogs and personal stories at Mad in America, he prizes the accounts of those with lived experience of the psychiatric system and hopes to create alternatives to the biomedical model.

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28 COMMENTS

  1. “The outcome was psychosis severe enough to require a diagnosis and prescription of antipsychotics.” Do doctors not have brains? If a drug causes a problem, take the child off the drug, don’t just prescribe more drugs.

    Oh, this explains it. “One limitation of this study is that they required both a diagnosis and prescription of antipsychotic medication in order to count the person as having experienced psychosis. If the person experienced less severe psychotic symptoms or was not prescribed medication, they would not count for this survey. Thus, it’s likely that the rate of psychotic symptoms was actually much higher than reported.”

    Absolutely, any patient who had a doctor with a brain in his head, was excluded from the survey. And when research only includes patients who have stupid doctors, this will of course result in studies “on stimulants … being ‘of very low quality’ and at ‘high risk of bias.'”

    One has to wonder what actual percentage of people become psychotic from these drugs. And if, prior to prescribing them, the patients and their families are being given informed consent that these drugs can cause psychosis?

    I know all my doctors denied up, down, left, right, and backwards that the antidepressants and antipsychotics could cause psychosis, despite all being taught in med school that the anticholinergic drugs can cause psychosis.

    https://en.wikipedia.org/wiki/Toxidrome

    It seems our medical community needs some classes on ethics, and should probably stop prescribing the drug classes that create psychosis.

    • This was my strong reaction! For every case where someone was dense enough not to recognize that stimulants were causing the problem and instead the child was diagnoses with a “psychotic disorder” and prescribed another drug, there have to be at least 10 where the doctor or the parent or the child him/herself was smart enough to say, “Hey, this shit’s making him/her nuts! We need to get them off immediately!” If this is true, then suddenly we’re going from .2% to 2%, which is hardly negligible. And we’re only talking about psychotic episodes here. A Canadian Journal of Psychiatry retrospective study of 100 kids’ files showed an over 6% rate of psychotic symptoms in kids taking stimulants for “ADHD,” which means it’s happening in one kid out of every 16 kids who is taking the drug. With millions of prescriptions out there, there are at least hundreds of thousands of kids experiencing psychotic symptoms as a result of their “treatment.” Yet we’re just “discovering” this now?

      “And in other news, people who are cut have a tendency to bleed…”

  2. Peter, regarding the last lines about studies of stimulants being at high risk of bias: Does that mean the findings above are not to be trusted, or that previous studies are not to be trusted? Or something else.

    In any case, this is scary stuff. I follow discussion boards for parents of kids with mental health issues, and so many of the youth who have ADHD diagnoses and are on stimulant drugs seem to have many other, more serious diagnoses as well. Can’t help but wonder if the ADHD meds triggered the “new symptoms” of a so-called co-morbid illness….

    • I like this research news….published in the nemj…
      it is a part of CRITICAL psychiatry….this is the type
      of news that will take down the BAD STUFF from within…
      the problem with anti-psychiatry —-it is not going
      anywhere….a lot of heat and not enough light…

    • “Drugs for ADHD are dangerous. We don’t know much about their long term harms, but we do know that they can damage the heart in the same way as seen in long-term cocaine addicts and lead to death, even in children. (Ref).
      We also know that the ADHD drugs cause bipolar disorder in about 10% of the children, which is a serious condition”(Ref).
      Professor Peter C. Gotzsche. “Deadly Medicines and Organised Crimes”. – How Big Pharma Has Corrupted Healthcare. (Page 194. Chapter 17. “Psychiatry, the drug industry’s paradise”.

    • I have seen many, many cases of this working with foster kids. Stimulants cause aggressive behavior, or less commonly, mania and even frank psychosis, and instead of stopping the stimulants, they add more drugs to “treat” the adverse effects, and of course that requires new “diagnoses” as well. Part of the “juvenile bipolar” explosion was due to stimulant adverse effects being diagnosed as ‘bipolar disorder.’ Ironically, they are often prescribed antipsychotics, which reduce dopamine transmission, while still being given stimulants, which INCREASE dopamine transmission. But as many times as I pointed out this contradiction, only one psychiatrist ever listened to me that I remember.

      • I’ve also run into this deafness in psychiatrists. I have come to the conclusion that they know that what they’re doing is causing harm but they don’t want to upset the lucrative apple cart that they’re pushing along in front of them. If they admit that there are huge problems with what they’re doing to people, especially kids, they’d have to find another source of income for themselves. I understand that this is difficult to look at but they have ethical and moral obligations to stop doing what they’re doing. They’re the ones who want to be known as real doctors. Even though the Hippocratic oath doesn’t contain the line, “First do no harm”, it doesn’t mean that it isn’t good medicine to practice it anyway.

  3. “By about 1960, widespread consumption had begun to make amphetamine’s negative health consequences more evident. Amphetamine psychosis had already been observed in the 1930s among long-term narcoleptic users of the drug, and individual case reports mounted during the 1940s and early 1950s.41 Initially, psychotic episodes were attributed to latent schizophrenia “unmasked” by the drug or to some other preexisting psychiatric pathology in the user.42 In Philip Connell’s definitive 1958 study of 40 cases, however, the British psychiatrist persuasively showed that amphetamine psychosis could happen to anyone, and eventually would, given enough of the drug” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377281/

  4. let’s see…the US leads the way in “ADD/ADHD” labels, and not just for kids…adults, even older adults get the label and the pills. In many other nations, -when- an upper is used, its some flavor ritalin. in the US, amphetamines dominate the market…in fact, the US is one of few nations to still offer prescription methamphetmaine (Desoxyn). good ole benzedrine has even made a comeback…it is now Evekeo. oh, wait…

    “Bipolar I disorder” has gone from being strictly defined and far less commonly diagnosed than, say, the 31 flavors o Schizophrenia found in the 50s and 60s, to being far more loosely defined (“Bipolar spectrum”) and it is now, fairly recently, “on the upwsing.” Interestingly enough…

    the increasingly “Bipolar I-V” masses can be “effectively treated” with “atypical” neuroleptics, the same drugs used on “Schizophrenic/Schizoaffective” people, “ODD,” “severe depression,” “personality disorder,” and those with “anger managment.” these shiny, new pills are $$$, but fret not…

    the gov’t ends up paying for something like 60-75% of ongoing ‘atypical’ neuroleptic prescriptions. for those whose insurance provider “lacks insight” into the “need for treatment,” NAMI can help! there is probably a ‘patient assistance program,’ too!

    its just…so…ridiculously cruel, the whole damned thing, isn’t it? 🙁

  5. Cruel!!! I keep trying to make sense out of this. I think I will just stick with cruel. Thank u for clearing that up for me. Here is more ridiculousness… Now when the ADHD drugs cause psychosis they label children with Bipolar at any age. I have recently heard of Juvenile Bipolar. When I was Diagnosed Bipolar 1 in 1987 bc my parents literally drove me crazy, the field said they could not dx Bipolar until a chlid is 17 years old. What happened to that?

    • You wouldn’t expect the powers that be to admit they were irresponsible dummies who didn’t know squat about the drugs they were prescribing and therefore wired their young patients into hallucinating and bouncing off the walls, despite it being general knowledge that stimulants frequently do this?

      • Wow. I keep thanking all of u bc the truth is so new to me. You all have the right answers to my questions. I think you are so right. The diagnosing of young children with Bipolar goes right along with the ADHD fraud. I plan to keep reading all you guys are writing and keep thanking u all. I did not watch Twilight Zone but I feel like I am in one. And anyone who can help the children and teenagers escape psychiatric drugs please please keep up the fight. As a teenage survivor (now an adult) of iatrogenic bipolar this has truly truly been a living hell. Thank You MIA.

      • Because he promised to get the diagnosis attached to children if the drug company would pay him a million dollars. Which drug company was it? Johnson and Johnson comes to mind but that might not be the correct one. Johnson and Johnson is responsible for so many crimes against humanity that it’s the first one that pops into my mind these days no matter what it is.

        • I am too new at the truth. I want to help but dont know what to do other than point out how wrong this has been for me. i googled Joseph Biedermann. It states he works out of Mass General. I paid Mass General’s Reproductive Psychiatry Dept. a small $500 dollars bc they dont take my ins. I went there to find out if it was safe for me to stay on my “meds” if pregnant. Their answer was it is better to stay on them then come off them and then need large doses at once. WRONG WRONG WRONG. If this Joseph Biedermann is responsible for this ADHD fraud for 1 million dollars… I cant say the rest.

          • I realize my comments are very very uneducated compared to what you guys know. How nieve to think I can say how wrong it was for me and that will do anything. You all know they are wrong. They even know they are wrong. This is my first experience w true evil that harms children.

  6. Interuppted sleep and poor sleep and apnea is a major contributer to ADHD. This is often caused by dominant mouth breathing due to many factors usually ending in poor facial development malalligned teeth and other physical distortions . Awareness of All of this is beginning to come to dentists, orrhodontists, pediatricians and ENT physicisns slowly through associations like Airway Focussed dentistry and orofacial myologists http://www.learnairwaydentistry.com/about-us.html and here’s a brief video showing a typical serious case
    https://www.google.com/search?q=finding+connor+deegan&ie=UTF-8&oe=UTF-8&hl=en-us&client=safari

        • try not to focus on that. when i was at my lowest points, i read over people who moved on from psychiatry at its absolute worst…the people who’d been operated ona nd moved on, that kinda thing…

          even before I became a Christian, i was convinced that there’s a spirit and even a mind that exists outside of the body, brain included. ‘where there’s life there’s hope.’

          • “Outside the body” is a metaphor since souls don’t occupy space and are not substances. Independent of is what I believe.

            I have read monist psychiatrists ridiculing the “idea that the mind is a separate substance in the brain.” Perhaps they think the concept of mind or soul we hold is ectoplasm similar to the glowing slime in Ghost Busters?

            May not be a Strawman Fallacy. Psyches are incomprehensible to these psychiatrists.

            Even atheists like Szazs believed in the power of mind over brain.

          • Thank you for advice. I am really really looking forward to my future and enjoying each day now as much as I can. Thank you for reminding me not to get stuck in the past.

    • What does this mean? Now they are going to align our teeth and perform oral surgery or do whatever another Medical Doctor ENT suggests bc our teachers are not as smart as us and boring us or bc our parents are secretly abusing us at home. And that interferes with our ability to “pay attention” at school? I am just so confused by all this???

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