Summary: Adderall-induced psychosis refers to psychotic episodes, such as hallucinations and delusions, that occur after using the ADHD medication Adderall, a phenomenon occurring with greater frequency among college students and young adults.
Key Points:
- New research shows ADHD medications with amphetamine may increase risk of first-episode psychosis.
- Amphetamine and dextroamphetamine are the active ingredients in the medication Adderall
- Academic pressure causes some college students to misuse Adderall
- Students at competitive schools are at higher risk of Adderall misuse
Adderall-Induced Psychosis Among College Students
In the publication “Risk of Incident Psychosis and Mania With Prescription Amphetamines,” a group researchers from Mass General Brigham McLean Hospital in Belmont, Massachusetts report the results of a study with the following goal:
“To examine the impact of dose levels of prescription amphetamines on the risk of this rare but serious adverse outcome.”
This study follows on the heels of research documenting the incidence of psychosis and mania among children and adolescents with ADHD receiving treatment with stimulant medication, which resulted in warning labels attached to most ADHD medications. However, it’s important to note here that the medication of primary concern is Adderall, which contains amphetamine, in contrast to Ritalin, which contains methylphenidate.
With regard to methylphenidate, a.k.a. Ritalin, the most common drug prescribed for ADHD among children and adolescents, the research team offers this observation on the current state of knowledge:
“A 2-year prospective cohort study in children and adolescents with ADHD with and without methylphenidate use did not identify an increase in psychotic symptoms with methylphenidate use.”
That’s why the research team focused on Adderall. For the most part, previous research ruled out an association between methylphenidate and psychosis. In addition, research shows college students are more likely to misuse – and use higher doses – of ADHD medication, compared to other demographic groups.
Let’s take a look at the study.
Adderall, Risk of Psychosis, and College Students
To conduct the study, researchers examined data from 1,300+ case studies and 2,700+ control subjects during a fifteen-year period between 2005 and 2019. Case studies included patients 16-35 hospitalized for psychosis or mania. Control subjects included patient 16-35 hospitalized for other psychiatric conditions, predominantly anxiety and/or depression.
First, let’s briefly examine research on the prevalence of and reasons for Adderall misuse among college students.
Adderall Misuse Among College Students
- Prevalence: 11.1% of college students reported misusing prescription stimulants.
- Competitive schools: Adderall misuse highest among students 18-25 attending colleges with highest admissions standards.
- Study aid: the majority of students who misused Adderall used it to improve grades.
Now, back to the study at hand. Previous research establishes a clear connection between elevated levels of dopamine in patients with psychosis, with symptom severity correlating with levels of circulating dopamine. In addition, previous research shows amphetamines increased the amount of dopamine circulating in the brain.
Therefore, researchers hypothesized that the increased levels of dopamine caused by amphetamine misuse for study purposes may increase risk of psychotic episodes, psychosis, or first-episode psychosis among college students.
The research team examined the association of the following medications with presence of psychotic symptoms, i.e. Adderall-induced psychosis:
- Amphetamine/dextroamphetamine, e.g. Adderall
- Dextroamphetamine, e.g. Dexedrine
- Lisdexamfetamine, e.g Vyvanse
More specifically, researchers examined the relationship between the following dosages of those three medications with likelihood of developing psychosis or mania:
- Low dose: < 15 mg/day
- Medium dose: 15-30 mg/day
- High dose: >30 mg/day
Let’s take a look at the results.
Amphetamine Medication and Adderall-Induced Psychosis
After gathering data, controlling for the presence of co-occurring mental health disorders and/or substance use disorder, the researchers identified increased risk of psychosis among young adults and college students who used amphetamine medication.
First, the big picture statistics.
Prescription Amphetamine Use in Past Month: People 16-35
- Total: 10.1%
- Case studies: 14.9%
- Low dose: 4.1%
- Medium dose: 4.4%
- High dose: 3.6%
- Controls: 7.7%
- Low dose: 3.5%
- Medium dose: 2.3%
- High dose: 1.3%
- Case studies: 14.9%
As we can see, a significant number of young adults and college-age people use prescription amphetamines, with rates decreasing for higher doses. Now let’s look at whether amphetamine use – and dosage level – affected risk of psychosis.
Percent Increased Risk of Psychosis With Amphetamine Use
- Any prescription amphetamine use:
- All doses: 62.3% increased risk
- High dose: 81% increased risk
- By specific dosage, odds ratio (OR):
- Low dose: 1.79
- Medium dose: 3.51
- High dose: 5.28
- Among hospitalized case studies vs. outpatient controls (OR):
- Low dose: 1.01
- Medium dose: 2.36
- High dose: 13.58
If you’re unfamiliar with interpreting odds ratios – the OR above – then we can confirm this data identifies higher risk of psychosis for higher dosages of amphetamine medication for ADHD. The two figures that cause alarm:
- People taking a high dose – over 30 mg/day – of prescription amphetamine showed a 428% increased risk of psychosis.
- People hospitalized for psychiatric reason who were taking a high dose of prescription amphetamine, compared to non-hospitalized control patients, showed a 1258% increased risk of psychosis.
We’ll discuss these results below.
How This Information Helps Us Help Our Patients
When we read this data in light of our knowledge of Adderall misuse among college students, we see warning signs: although the overall incidence in the population is small, the risks of Adderall-induced psychosis are real, and they’re something all college students should understand.
We’ll state it this way:
Taking Adderall, or any amphetamine medication without a prescription, can increase risk of psychosis, with risk increasing as dosage increases.
Here’s how the researchers characterized the findings – and what we can do in response:
“This case-control study identified an increased odds of incident psychosis or mania with prescription amphetamine use, where increasing dose levels of prescription amphetamines were associated with higher risk. Our findings suggest that clinicians can mitigate the risk of psychosis or mania by avoiding doses above 30 mg dextroamphetamine equivalents.”
This information can help us better support our neurodivergent patients who may require prescription medication, and expand our understanding of the causes of psychosis in our college-age and young adult patients
Gianna Melendez
Jodie Dahl, CpHT