Teens and young adults taking amphetamine-based medications for the first time for treatment of attention deficit hyperactivity disorder (ADHD) may face an increased risk of developing psychosis, according to the findings of new research.
In a study published this week in the New England Journal of Medicine, individuals with ADHD who take drugs from both the methylphenidate class, sold under the brand-names Ritalin, Daytrana and Concerta , among others, and those taking amphetamines, like Adderall and Dyanavel XR, have an increase psychosis risk. However, the risk is significantly higher with Adderall and other amphetamines.
Harvard researchers analyzed data from two commercial insurance claims databases, focusing on patients 13 to 25 years old who received a new diagnosis for ADHD between January 1, 2004, to September 30, 2015, and started taking either type of stimulant drug to treat ADHD in the first few months.
Researchers assessed 338,000 teens and young adults who received a prescription for ADHD medications. Nearly 111,000 patients were taking a methylphenidate, like Ritalin, and approximately 110,000 patients were taking an amphetamine, like Adderall.
A total of 343 episodes of psychosis were documented during the first 60 days of taking the prescription. Roughly 100 episodes occurred in the Ritalin group while 237 episodes occurred in the amphetamine group.
This equaled to about 1 in 660 young people who developed psychosis. Most had no significant psychiatric history.
The risk was higher among patients who took Adderall compared to Ritalin. Patients taking Adderall had a 65% increased risk of experiencing some kind of psychotic event.
ADHD Drug Risks
ADHD is a developmental disorder which is characterized by symptoms of inattention, hyperactivity, and restlessness or impulsivity. Stimulants, like Adderall and Ritalin, are prescribed and have been shown to be effective in controlling symptoms.
Current FDA guidelines recommend Adderall or Ritalin to treat ADHD. Teens are now four times more likely to get a prescription for Adderall and 1.6 times more likely to receive a prescription for Ritalin than they were in 2004.
The U.S. Centers for Disease Control and Prevention (CDC) warn more children are being treated for ADHD with medication than with behavioral therapy.
Both drugs work through the dopamine pathways in the brain. However, Adderall is more likely to cause a release of dopamine, while Ritalin is more likely to block the reuptake. A surge of dopamine during a psychotic episode closely mimics the surge seen after stimulant use, which could be why psychosis is a risk for patients taking the drugs, researchers noted.
The risk of psychosis for patients who have been taking the medications as prescribed and for some time is low compared to patients who are taking the drugs for the first time.
Researchers hope the findings of the study help prompt a discussion between patients, parents, and doctors about the risks and benefits of taking stimulant drugs, as well as any alternative treatments, such as behavioral therapy and non-stimulant drugs.
In 2007, the FDA mandated changes to drug labels for stimulants warning about the risk of psychosis in patients with no prior history. However, the researchers say this is the first time a study has been conducted into which of the stimulants was more likely to cause psychosis.
Ritalin and Adderall also carry other risks. In 2015, the FDA added another warning to drugs like Adderall and Ritalin, indicating they can cause kidney injury and rhabdomyolysis, a serious form of muscle injury. Ritalin may also increase the risk of a child experiencing abnormal heart rhythms.