In recent years, there have been numerous concerns raised about the overdiagnosis of ADHD, with some researchers emphasizing how research and industry biases have fueled this. Additionally, there has been a greater spotlight on the use of stimulants for children diagnosed with ADHD. While many adverse effects of prolonged stimulant use have been explored, one of the less discussed consequences is the development of psychotic symptoms.
The researchers of this study sought to explore the proportion of individuals diagnosed with ADHD and prescribed stimulants who go on to develop psychotic and bipolar symptoms. By comparing existing research, they found some evidence of a causal link, with rates falling between 2.8 and 3.7%. As the authors note:
“Although not remarkably high, a 2.8% development of psychotic symptoms represents a non-negligible figure and lends further meta-analytic support to the 2007 US Food and Drug Administration (FDA) change in the drug label for stimulants, alerting on the possible occurrence of psychotic symptoms.”
The rates of psychotic symptoms were significantly higher for individuals treated with amphetamines, such as Adderall, as compared to methylphenidate, such as Ritalin. Higher doses were also associated with an increased likelihood of developing psychotic symptoms. Meanwhile, data from the FDA finds that when psychotic symptoms are present, discontinuing stimulant use alleviates these symptoms in 90% of cases.
This is the first pooled study of its kind, and the authors stress the need for additional research. While the authors make a call for careful monitoring and psychoeducation when prescribing stimulants, the findings also highlight the need for alternative treatment options. As they note:
“Based on available studies, it was not possible to differentiate the effect of the medication from that of ADHD itself as we could not include a consistent control group of individuals with ADHD who were not treated with stimulants.”
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