A type of commonly-used medication prescribed to treat attention-deficit hyperactivity disorder (ADHD) has been linked to a higher risk of psychosis. A study suggests that another type of ADHD medication carries a far lower risk, but doctors are reluctant to prescribe safer medications over riskier drugs. 
“We looked at new users, people who are being prescribed these medications for the first time.
We compared amphetamines, which is Adderall and Vyvanse, to people who were prescribed methylphenidates, which is Ritalin or Concerta. We found that Adderall-type drugs had an increased risk of psychosis.”
Rates of ADHD have climbed sharply in recent years. More than 6 million children and teens in the U.S. have been diagnosed with the disorder, which causes difficulty concentrating, hyperactivity, and impulsiveness.
In the U.S., 5 million people under the age of 25 are prescribed ADHD medications.
For the study, Moran and her colleagues looked at data from two large commercial insurance claims databases on patients ages 13 to 25 years old with an ADHD diagnosis who began taking amphetamines or methylphenidates between 2004 and mid-2015. The sample included more than 220,000 patients.
One out of every 486 patients who started taking an amphetamine developed psychosis which required an antipsychotic medication, the analysis revealed. By comparison, just 1 in 1,046 patients taking a methylphenidate developed the condition.
Psychosis can best be described as a mental condition characterized by a disconnection from reality. People with psychosis may hallucinate, hear voices in their head, and experience delusions, such as the false belief that the government is following them or that they are in danger.
“Often, when people develop psychosis, they don’t have insight so they don’t even realize that they are impaired. They think these things are really happening. It’s very scary.”
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The researchers say the increased risk of psychosis associated with amphetamine use is low, but it is no less significant, as the use of amphetamine medications in adolescents and young adults has more than tripled in recent years.
“It seems that doctors are choosing to start people on Adderall even though existing guidelines suggest that both stimulants have similar effectiveness. So there needs to be a dialog between patients and doctors about why they’re choosing Adderall over Ritalin-type drugs.”
Not So Surprising
The findings are not entirely shocking to the scientific community. The U.S. Food and Drug Administration (FDA) required stimulant manufacturers in 2017 to add a warning to their products about the risk of psychotic episodes or manic symptoms. 
However, the team says that people who have been taking Adderall or Vyvanse for quite some time without any problems shouldn’t worry. The study only looked at new users, and most of the psychotic episodes occurred in the first few months of treatment. 
Moran said: 
“If someone has been on Adderall, they’re tolerating it well, it’s helpful for their symptoms, and they’re taking it as prescribed, there’s really not much cause for concern.”
The increased risk is more of a concern for those with a family history of bipolar disorder or a psychotic disorder. 
“I might shy away from Adderall in patients with that kind of history.”
The next step is for the team to “identify risk factors that actually increase one’s risk, so we can narrow down who really is at increased risk with Adderall,” Moran added. 
Chemically speaking, Adderall and meth are very similar. If that’s a concern for you or someone in your family who has ADHD, other treatments – including behavioral therapy and training for parents – are also available. 
 CBS News