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Alert: High Doses of Adderall May Increase Risk of Psychosis, Study Finds

A new study reveals that using ADHD stimulants at higher doses may be significantly linked to an increased risk of psychosis and mania. The research emphasizes the importance of closely monitoring individuals using these medications, especially at elevated doses, to prevent severe side effects.

The Case of Julianna McLeod: An Important Warning

Julianna McLeod, 26, experienced her first psychotic episode while taking Vyvanse to treat her ADHD last year. A resident of Ontario, Canada, Julianna had used the medication before but stopped during her pregnancy. She resumed taking it six months postpartum, but due to her busy schedule, she often forgot her last dose and sometimes took more than one capsule daily, exceeding the prescribed 40 mg limit.

She described the delusions as euphoric and energizing experiences. In her mind, she was a “super detective” uncovering child trafficking networks, even believing that someone was drugging her and her baby.

This type of psychosis is a rare side effect of stimulant medications like Vyvanse and Adderall, which are used to treat ADHD. The U.S. Food and Drug Administration (FDA) has added warnings to the packaging of these medications, cautioning about possible symptoms such as hallucinations, delusional thinking, or mania. However, these effects are considered uncommon, affecting roughly 1 in every 1,000 patients, and research on the topic has been limited until now.

The Link Between High Doses and Psychosis

A recent study published in the American Journal of Psychiatry highlighted a new correlation: the dosage of amphetamines, such as Vyvanse and Adderall, appears to directly influence the risk of psychosis and mania. Researchers found that individuals taking high doses of these medications had a fivefold increase in risk of developing these symptoms compared to those not using stimulants.

High doses were classified as more than 40 mg of Adderall, 100 mg of Vyvanse, or 30 mg of dextroamphetamine. The risk was 3.5 times higher in patients taking moderate doses, such as 20-40 mg of Adderall, 50-100 mg of Vyvanse, or 16-30 mg of dextroamphetamine.

Interestingly, the study found no correlation between the use of other stimulants, like methylphenidate (found in Concerta and Ritalin), and an increased risk of psychosis, regardless of dosage.

Who Is More Susceptible?

According to Dr. Lauren V. Moran, the study’s lead author, it is challenging to predict exactly who will develop psychotic symptoms while taking amphetamines. However, the study indicated that patients with a family history of psychotic or bipolar disorders, daily cannabis users, and those taking stimulants without a prescription had a higher risk. Additionally, patients over 23 years old were more likely to exhibit psychosis or mania, possibly due to being prescribed higher doses.

A Growing Concern

In the United States, the number of stimulant prescriptions has steadily increased since 2012, reaching around 79 million in 2022, according to a report by IQVIA. Although only a small fraction of these patients develop psychosis, the impact is substantial, warns Dr. Moran.

The research reviewed records of patients aged 16 to 35 who were hospitalized for the first time with psychosis or mania between 2005 and 2019. The results showed that high-dose amphetamines were the factor most strongly associated with an increased risk of these psychiatric episodes.

Care and Monitoring

Dr. Sharon Levy, head of the addiction medicine division at Boston Children’s Hospital, described the study’s findings as “compelling evidence” that high doses of amphetamines may contribute to the onset of new psychotic disorders. The next step will be to determine if this pattern is consistent in populations beyond patients at McLean Hospital.

While further studies are underway, Dr. Moran recommends that individuals on moderate or high stimulant doses be closely monitored and regularly evaluated for signs of psychosis or mania. As illustrated by Julianna McLeod’s experience, these conditions can be extremely disruptive and take a long time to fully resolve. Although she has recovered and is now on a significantly lower dose (10 mg of Adderall), the trauma of her experience lingers.

Conclusion

Using stimulants for ADHD, especially at high doses, can carry a significant risk of psychosis or mania. Although these side effects are rare, it is crucial that doctors and patients remain vigilant for warning signs. Constant monitoring and strict adherence to prescribed doses are essential to minimize risks. As more research emerges, new guidelines and preventive measures may be implemented to protect users of these vital medications.

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