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The drug Adderall, a popular treatment in the United States for attention deficit hyperactivity disorder (ADHD), has raised concerns among researchers because of rare but serious side effects, as prescriptions in the country have increased sharply over the past two decades.
According to a study published Thursday, people taking high doses of this stimulant — which is not available in France — run a risk more than five times higher of developing psychosis (loss of contact with reality) or mania (phase of abnormally high energy, erratic behavior).
A boom in psychoses during confinement
There are no clear guidelines on maximum doses, and the number of younger adults using the drug has increased since the Covid-19 pandemic, largely as part of the rise of telemedicine.
The study was conducted by a team led by psychiatrist Lauren Moran of Mass General Brigham Hospital in Boston. Moran became interested in the topic earlier in her career, after seeing many college students seek medical attention.
“We were seeing a lot of people come in without much of a psychiatric history and develop a first episode of psychosis or mania in the context of stimulant use.” she explained to AFP.
When the U.S. Food and Drug Administration (FDA) learned of these cases in the 2000s, it added a warning to the drug label. But relatively little research has been done to quantify side effect rates or how they relate to dosage.
Risk of psychosis multiplied by 5 with high doses
Lauren Moran and her colleagues looked at medical records of people aged 16 to 35 who were admitted to Mass General Brigham hospitals between 2005 and 2019. This is the typical age of onset for psychosis.
The researchers identified 1,374 people experiencing their first episode of psychosis or mania, and compared them to 2,748 patients hospitalized for other psychiatric disorders.
By analyzing Adderall use over the past month and taking into account other variables such as drug use, they were able to specifically determine the impact of stimulants.
They found that people who took Adderall were 2.68 times more likely to have been hospitalized for psychosis or mania than those who did not take it – and that odds rose to 5.28 times for higher doses (40 milligrams and above).
No increased risk with Ritalin
A separate analysis found no increased risk with Ritalin, another stimulant prescribed for ADHD. Moran said that may be due to differences in how the two drugs work.
They both increase levels of dopamine, which is involved in motivation and learning. However, while Adderall, an amphetamine, increases dopamine release, Ritalin works by blocking its reabsorption.
Moran said the study demonstrates the need for clear maximum doses on labels. Labels currently recommend treating patients with 20 milligrams, but in practice, doctors prescribe doses that vary widely.
This is partly because more advanced ADHD symptoms require a higher dose.
“A negligence in the prescriptions”
But the researcher has sometimes observed “negligence in prescriptions.” Patients can also manage to find a doctor who agrees to prescribe the desired dose.
“People, like some doctors, may think that it is possible to eliminate all symptoms of ADHD, but this is not realistic.” added Lauren Moran.
Telemedicine services have been criticized for overprescribing Adderall, contributing to shortages that can deprive those who truly need the treatment. The drugs are also known to be misused by students during exam periods because they are said to improve concentration.
The Drug Enforcement Agency (DEA) proposed revoking the authorization for Aderall to be prescribed by these telemedicine services, but in the face of an outcry, it ultimately extended the authorization until the end of 2024.