Scientific Asia: A new Mass General Brigham study found that Adderall users at high doses have a higher chance of developing mania or psychosis.
Researchers at the psychiatric teaching hospital McLean Hospital discovered that high dosages of the prescription drug amphetamine were associated with a five-fold increased risk of mania or new-onset psychosis. Those taking 30 mg or more of dextroamphetamine—which is equivalent to 40 mg of Adderall—were at the highest risk of developing psychosis and mania.
Lead study author Lauren Moran, a pharmacoepidemiology researcher at McLean Hospital, said, “Stimulant medications don’t have an upper dose limit on their labels, and our results show that it is clear that dose is a factor in psychosis risk and should be a chief consideration when prescribing stimulants.”
As an inpatient psychiatrist, Moran said that her previous clinical observations served as the impetus for the study. She and her McLean colleagues noticed patients going through initial episodes of psychosis frequently, and their medical records showed their doctors had prescribed excessive amounts of stimulants.
The investigators examined over fifteen years’ worth of admissions to the emergency room at all Mass General Brigham hospitals. The researchers discovered that 81% of occurrences of psychosis or mania among amphetamine users on prescription may have been avoided if they had not been taking such high doses. “Whenever these medications are prescribed, patients and their doctors should monitor this rare but serious side effect,” stated Moran.
Methylphenidate (Ritalin) use did not result in a substantial dose-related risk increase, while patients receiving high dosages of amphetamine did. According to Moran, the results shouldn’t be alarming, but they should make doctors administer these drugs with more care, especially for people who have a higher risk of psychosis or mania.
According to Moran, there is little proof that prescription amphetamines work better at higher dosages. “Doctors should think about other drugs that our research indicates are less dangerous, particularly if a patient is at high risk for mania or psychosis.”
The normal age range for the beginning of psychosis and schizophrenia is 16 to 35 years old, therefore the researchers focused on adult patients between 2005 and 2019 who had interactions with Mass General Brigham in their electronic health records.
Following referrals from other institutions within the Mass General Brigham healthcare system, all patients were admitted to McLean Hospital.
1,374 cases of first-episode psychosis or mania were found by the researchers, while 2,748 control patients were hospitalized for mental health issues such as anxiety or sadness. To separate the effects of stimulants, they compared the use of the drugs over the previous month and took into consideration other variables, such as substance use.
Researchers discovered that if amphetamine users had not been taking such high doses, 81% of cases of psychosis or mania may have been prevented. 1,374 cases of first-episode psychosis or mania were found by the researchers, while 2,748 control patients were hospitalized for mental health issues such as anxiety or sadness.
To separate the effects of stimulants, they compared the use of the drugs over the previous month and took into consideration other variables, such as substance use.
Researchers discovered that if amphetamine users had not been taking such high doses, 81% of cases of psychosis or mania may have been prevented.
Over the past ten years, there has been a notable increase in the prescription rates of stimulants used to treat attention-deficit/hyperactivity disorder (ADHD); among of the biggest increases in this regard has been documented during the COVID-19 pandemic.
