Psychosis From Adderall?

If you worry about headlines reporting new research findings, look at the facts before making a decision. Headlines are written to get your attention. They never tell the whole story and even statistics can be used inappropriately.

Headlines are designed to grab your attention. Recent headlines about Adderall and other ADHD medications are scary. This is another example of media misinterpreting a study with the headline. I’ve written before about Adderall being misrepresented by headlines.

When headlines say something shocking, don't just believe them. Read critically. The study that shows adderall decreases brain function doesn't apply to those with ADHD.
Stimulants decrease brain function? Say what?

In this post I will generally refer to stimulants by their common names. Adderall is in the amphetamine family and as used here could include other named medications in that family. Ritalin is in the methylphenidate family and as used here includes other medications in its family.

New: Psychosis with Methylphenidate or Amphetamine in Patients with ADHD

That sounds like a typical headline. It’s eye-catching, right? It won’t be something you forget if you take Adderall or are considering starting it.

If these medicines have been working well for you and you aren’t hearing or seeing things, you don’t need to stop them.

How can I say that? Am I not worried about someone becoming psychotic?

We always need to look at studies critically. The title of an article, or even the summary, can be misleading. Attempt to read the study itself, but if you are unable to, find a summary by an expert in the field.

Limitations in the study

This study actually fares well in many of the above things to consider when evaluating a study. It’s a respected journal and there’s a large sample size, but it’s not a double blind controlled study. It’s a review of insurance codes. This can be fraught with many problems.

Study design

The study was a review of codes from national insurance claim data. It included teens and young adults who were starting these medicines for the first time. They reviewed codes for diagnoses as well as prescriptions. They did not have any direct study of the patients. Anyone who was doing well on these medications already was excluded.

Unable to accurately assess disqualifiers

Anyone who had filled a prescription for a stimulant in the year prior to the study was disqualified. That means the many, many people who use stimulants with great benefit for years were not included. There is no comparison to total number of prescriptions for this.

We know that many people will self medicate with someone else’s medicine. There was no way to assess if they used someone else’s prescription medication, so there could be misrepresentation of new medication starts in the study population. This means even one of their qualifying conditions cannot be verified.

Inability to assess if patients accurately took medicine

We all know that people will fill prescriptions that they don’t take as directed.

There is no way to tell from this study design if the patients took their medicine regularly, or even at all.

Adderall has a larger street value than ritalin, so if more of the patients who were prescribed adderall diverted their medicine to someone else, they were still included in the psychosis number. This could sway the numbers making adderall look more problematic than ritalin because they weren’t being medicated. Said in another way: if people are more likely to take their medicine, they’re less likely to have psychosis.

This is just a thought. I have no way of knowing this information based on the study design. I include it because this is the way we must evaluate study results. We need to consider the results and other possibilities and explanations critically.

What does double the risk really mean?

The age range studied is one at which schizophrenia and other psychoses tend to develop.

They compared psychosis rates to people treated with methylphenidates versus amphetamines and found the risk was double in those starting amphetamines. Double sounds huge, but it was still very small numbers.

No comparison

One big problem is that there was not a comparison to a baseline development of psychosis in people of the same age not on medication.

We would expect a small number of study participants to develop psychosis, whether they start the medicine or not. They did not attempt to compare this with their study population.

Incidence estimates of new psychosis in the general population in one study showed 126 per 100,000 among those aged 15 to 29. This means that about 0.12% of people are expected to develop psychosis in this age group each year.

Risk of psychosis in those with ADHD

We also know that people with ADHD struggle more with mental health.

Their overall risk of psychosis may be higher, but since they didn’t compare the same age range of people (with and without ADHD) who did not start any new medications during the same time frame, we do not know that baseline.

Study results

The recently announced study about new psychosis related to new amphetamine or methylphenidate shows 343 episodes of psychosis among the 221,846 study participants between 13 and 25 years of age. The group of people starting methylphenidate had a 0.10% risk and those on amphetamines had 0.21%.

The age groups in the studies are slightly different. We know that risk increases with age, so it should be further studied if the age range contributed to this difference.

Closer follow up matters

It is also possible that people who are starting a new medicine are more likely to be identified early in their psychosis.

Many adolescents and young adults rarely see physicians or other medical providers since they’re generally healthy. If they aren’t seeing someone who could identify psychosis, they would not get a diagnosis.

People who see someone who is prescribing stimulant medications are hopefully being assessed for mental health in general. It is expected that they are more likely to have problems identified.

This wouldn’t explain the difference between medicated groups, but could raise the incidence overall identified.

TL;DR

This study doesn’t convince me that the risk of psychosis is enough to avoid using it for the management of ADHD. Both amphetamines and methylphenidates have been used successfully in many people over the years.

If you have been treated successfully with any treatment and aren’t having significant side effects you should continue the treatment. Not treating has risks too.

For more reading

Methylphenidate and the risk of psychotic disorders and hallucinations in children and adolescents in a large health system Transl Psychiatry. 2016 Nov; 6(11): e956.

Tips to manage ADHD medication side effects

Are you struggling to control side effects from your ADHD treatment? Learn some tips to help manage them effectively so you can thrive with ADHD!

With everything we do, we must weigh risks and benefits. Many people with ADHD need help managing their symptoms, and that often includes medications. Unfortunately this treatment can lead to side effects. If we can manage the ADHD medication side effects, the risk to benefit ratio tips toward the benefit side.

1. Appetite suppression

A decreased appetite is common when stimulants, such as methylphenidates or amphetamines, are used. I have seen kids who gain weight better on their medicine because they can actually sit long enough to finish lunch, but most will lose a few pounds when they first start their medication. After the initial drop, most can maintain a healthy weight with some simple adjustments.

Make the most of non-medicine times

I often say that kids on stimulants don’t have eating disorders, but they have disordered eating. They eat at unconventional times.

Before meds kick in

Start your day with a healthy breakfast that includes protein, whole grains and fats. The typical American diet of cereal for breakfast is mostly carbs, which gives quick – but non-sustaining – energy.

Protein, fiber and healthy fats can provide longer-lasting energy.

Don’t limit yourself to “breakfast” foods. If a sandwich or leftovers sound good to you, eat that for breakfast.

As meds wear off

Before hanger sets in, grab a healthy snack at the time you start to feel hungry in the afternoon or evening.

If your parents try to make you wait for dinner, talk to them about how your hunger affects your mood and behavior.

Eating a healthy snack (or call it an appetizer) can help keep those under control. You should still be able to eat dinner, but if it affects your appetite, warm up last night’s dinner as your appetizer each day. You’ll still eat what the family eats, but it will be timed differently. Still sit with your family for the conversation if your hunger doesn’t coincide with the family dinner. Family meals are important!

After school if you’re hungry, grab a mini-meal. Heat up leftovers, make a sandwich, or grab a plant and protein pair.

Healthy pairings:

  • apple slices, grapes, or berries with cheese
  • bell peppers with cream cheese
  • berries and yogurt
  • cucumbers, carrots, bell peppers or snap peas with hummus
  • apple, banana or celery with peanut butter
  • smoothie made with fruits, vegetables, and yogurt
  • broccoli, carrots, cauliflower, snap peas or celery with a yogurt dip
Pair a plant and a protein for healthy eating! www.adhdkcteen.com

If you’re hungry after dinner, again grab a mini-meal type snack, not junk food.

Don’t waste empty calories

If you’re able to eat, pick the healthiest part of the meal first. Don’t start with the side dish or roll. Eat plants and proteins. Plants are fruits and vegetables, and most of us fail to get the recommended amount of these daily.

2. Moodiness

People with ADHD tend to be very sensitive and emotional in general, but medications can increase moodiness at times. Look for patterns about when the moodiness is the worst to help identify why it happens.

Some people get more irritable when their medicine is working, others as it wears off. This can be due to a medicine that’s not the best fit or at the wrong dose. Be sure to talk to your prescriber about how your medicine is affecting your mood.

Rebound

Many people experience a rebound of symptoms as the dose wears off. If this happens, some people can use non-medication changes, others require a medication adjustment.

If you can be alone during this time frame, that may be all you need.

Listen to music. Exercise. Read. Whatever helps you adjust.

If this isn’t sufficient, discuss adjusting the dose or adding a short acting dose in the afternoon with your prescriber.

When these medication adjustments aren’t sufficient, adding a non-stimulant medicine can help buffer the rebound. Again, talk to your prescriber.

Anxiety

Sometimes stimulants can can trigger an underlying anxiety.

Anxiety can look like anger or increase irritability.

It can lead to headaches, stomach aches and other physical symptoms.

Anxiety is a common cause of insomnia. Lack of sleep makes anxiety worse. It’s a hard cycle to break sometimes. Talk to your prescriber if you’re experiencing this.

When anxiety distracts, it can look like poor focus, which can be misintrepreted as too little stimulant. Increasing the stimulant makes it worse.

Anxiety often leads to avoidance, negativity, over planning and trouble with patience.

Help for anxiety

Therapy is the first line treatment for anxiety, but if it is caused by medication, adjusting the medication can help.

Sometimes adding another medication to help with the anxiety may be needed.

It is very important that you talk to your prescriber about any anxiety you have, whether it’s medication related or not. No one should suffer in silence.

Other causes of moodiness

Moodiness can be related to chronic sleep deprivation or hunger – see the related sections of this post to help manage those issues.

3. Sleep problems

Sleep problems are common in teens, especially those with ADHD. Sleep deprivation can lead to many problems, so it’s important to address them.

There are many things we can do to get more sleep. These are covered in How can I get better sleep?

If you think your medicine keeps you up, talk to your prescriber about changes that could help.

4. Stomachaches and headaches

If stomachaches or headaches seem to happen due to the medication, taking the medicine with food can help.

These symptoms sometimes only happen at the start of a new medication, when the dose is increased, or when resuming after being off of it for awhile. If this is the case, you should notice these side effects go away after consistent use.

When the stomachaches or headaches are persistent and not tolerable, talk to your prescriber to discuss changing medicine or changing the dose.

5. Tics

Repeated movements or sounds are known as tics.

Tic disorders are common in kids with ADHD:

  • About 20% of kids with ADHD have chronic tics.
  • Around half of all children with chronic tics have ADHD.

Tics can come and go. They often change over time, so an eye blink can go away and be replaced by a nose twitch or shoulder shrug.

Because of this natural cycle it can be difficult to decide if they’re on their normal cycle or worse due to medication.

While it was once common to believe that stimulants cause tics, there is evidence to the contrary.

Some people will even notice that their tics are less common when they’re on medication for ADHD, especially with guanfacine or clonidine.

If you note that tics increase with the start of a new medicine or an increase in dose, evaluate how these tics affect you. If they are minor, such as an eye blink, it is okay to ride it out. The tic will most likely continue to come and go and it’s not causing distress. If it causes you distress, talk to your presciber about behavioral therapy or a medication change.

6. Psychosis

Recent headlines have put psychosis and stimulants in the news.

Psychosis from Adderall is all over the news. Headlines are scary. Learn what you need to know. @adhdkcteen

In short, if you’re doing well on a stimulant, either amphetamines or methylphenidates, there’s no need to worry.

The study being reported is about new starts on these medications.

As is often the case, headlines are overestimating the risk. They are designed to make you want to read the article.

I am writing a whole post on this, so tune in next time… if you don’t want to miss it, sign up in the pop up or the right sidebar so you’ll get each new post in your in box. I promise to never use your email for any other purpose!

Meds don’t last long enough?

If your medicine doesn’t last long enough for your schedule, check out My Medicine Stops Working Too Soon!

If you still feel like you’re struggling…

Our next meeting will be all about growing up and thriving with ADHD.

Paula Smith-Culp from ADDvantagekc and Jonathan Kindler, a local therapist at Serenity Life Resource Center and KC Wolf alternate, will share their journeys from childhood to adulthood.

This presentation will be of interest for all ages living with ADHD. It will include experiential activities, and guidelines for using ADHD strengths in order to follow your passion from childhood to the workplace!

This will be a combined group of the parents and students. We appreciate your RSVP so we can plan seating, but if you decide to come at the last minute, you’re welcome to show up! All meetings are free and open to the public. RSVP here

Stimulants decrease brain function? Say what?

If you heard the recent news that stimulants decrease brain function, don’t freak out and immediately think you need to stop a medicine that helps you. The study was done in neurotypical (“normal”) people. There’s a big difference in what these drugs do in a brain that has imbalances of neurotransmitters and in a brain that does not, so don’t freak out. Read on to learn more!

If this is all too much information, you can jump to the TL:DR section, but it’s always good to learn the details!

What are stimulants used for?

Prescription stimulants are approved to use in the treatment of ADHD, narcolepsy, and obesity. They increase alertness and attention and often decrease appetite. Stimulants such as Adderall and Ritalin are considered safe for long term use in appropriate circumstances.

Stimulant misuse.

Misuse can lead to psychosis, anger, paranoia, heart, nerve, and stomach problems. Stimulants can cause heart attacks or seizures when used inappropriately. Misuse also can lead to addiction and tolerance, requiring higher and higher doses to get the same effect, increasing the risk of overdose.

Studies have shown that 20-30% of college students have taken a stimulant medication inappropriately within the past year.

The 2017 Monitoring the Future Report shows that 5.5% of high school seniors reported non-medical use of Adderall during the past year.

Adderall is the most commonly abused stimulant, but ritalin is used inappropriately too.

Why was this study done?

Many students believe that if Adderall and other stimulants help people with ADHD stay focused and perform better academically, it will improve their focus and make them smarter. Juggling school with all the extracurriculars, work and social life is hard. Many teens are sleep deprived and hope the Adderall will help them stay alert and study more effectively.

Since the use of stimulants by students without ADHD is common, many wonder if it’s true that they actually work to help focus in people without ADHD.

The big question:

Is Adderall safe and effective for those without ADHD?

What could be wrong with using it?

You might wonder why researchers care. Since many kids, teens, and adults are prescribed this medicine to help manage their ADHD, it should be okay for others to take, right?

Wrong.

There are many reasons to question the safety and efficacy of any medicine or supplement.

Drugs of abuse include stimulants but this does not mean they are dangerous for those who need them to treat a condition.
Source: https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts#prescription-stimulants

Legality

First and foremost, it is illegal to use someone else’s prescription medicine.

All prescription medicines are to be used by the person who it’s prescribed for. Stimulants are controlled substances. This means they are monitored closely by regulating authorities.

Controlled substances fall into various categories, ranging from Schedule I through V. Schedule I medications are the most dangerous. They have no known medical use, are unsafe, and have a high potential for abuse. The least dangerous category, Schedule V, has a small amount of narcotic quantity. Schedule II-IV fall in between.

Stimulant medications are in the Schedule II class. This class is considered to have a high potential for abuse and can lead to dependence. Please note that studies show that when children with ADHD take stimulants properly, they have a lesser risk of developing drug and alcohol problems. Even though there is abuse potential, the risk of all medicines should be weighed with the benefits.

When used properly, stimulants have medical benefits. If the medicine is prescribed to you, it is perfectly legal to have them in your possession and use them according to your prescription. But if they are someone else’s prescription, they are illegal to have and use. It is also illegal for you to sell or give your medication to another person.

Because these medications have resale value, it is recommended to keep your stimulants in a lock box when you live with other teens and young adults in college and early adult life. You can take a few out at a time to use as needed.

Right medicine at the right dose.

Most students who take stimulant medications have titrated their dose with the help of their physician to find the right medicine at the right dose. This can be a time of trial and error and needs to be monitored by a professional.

When friends share medications or people buy or steal stimulants from someone, they get what they get. They may or may not get a dose that is safe for them.

There are also fake drugs that are sold as stimulants but can be much more dangerous. It can be hard to tell the difference, so getting your medicine only from a licensed pharmacy is important.

If someone else is taking it, the person with the need doesn’t get it.

Many people downgrade their problems associated with ADHD. They might think they can get by with skipped doses, but they often underestimate the many benefits of their medication. Stimulants are not just needed for school.

Dr. Russell Barkley has been researching ADHD for 40 years and has found that ADHD is the single condition most associated with early death.

People with untreated ADHD tend to live up to 25 years less time than people without ADHD or with treated ADHD.

That means ADHD leads to early death more than tobacco, obesity, heart problems, and other chronic diseases when it’s not treated appropriately.

It makes sense that the issues associated with ADHD can lead to early death.

  • People with ADHD tend to be less focused. They are involved in more accidents when not medicated.
  • Many with ADHD impulsively overeat, which leads to obesity and the associated problems. In fact, obesity is five times more common in adults with ADHD versus the general population.
  • Many will self medicate with drugs and alcohol due to the secondary low self esteem, anxiety, and depression that is associated with ADHD.
  • The suicide rate is much higher for people with ADHD. They tend to have more depression and impulsivity than people without ADHD.
  • Risk taking behaviors are much more common in people with ADHD due to their impulsivity. They have a higher risk of starting negative habits, such as smoking, which are associated with shortening lifespan.

In short: don’t give or sell your medicines to anyone else. You need them!

A new study

When headlines say something shocking, don't just believe them. Read critically. The study that shows adderall decreases brain function doesn't apply to those with ADHD.
Stimulants decrease brain function? Say what?

Lisa Weyandt, a professor of psychology at the University of Rhode Island, studied how students without ADHD responded to Adderall. She wanted to test if it was true that Adderall could make people smarter and study more effectively if they didn’t have ADHD.

Study set up

It was a relatively small study. This means it shouldn’t be generalized yet. Bigger studies should be done.

She recruited 13 students to participate. They took a 30 mg dose of Adderall before one lab session and a placebo pill before another lab session. They were blind as to which pill they took each session. During the lab sessions passages were read to them and they had to answer a series of questions about them.

Researchers looked at how well they performed, their alertness, and their ability to focus on the Adderall and the placebo.

Results

Students showed improvements in alertness and focus with Adderall. Unfortunately these improvements did not help them think, remember or problem solve. They did not improve their reading comprehension, fluency, or recall of facts when they took the Adderall versus when they took the placebo.

Even worse: The Adderall actually inhibited their working memory. This is the ability to remember and use information to solve problems. People with ADHD often have problems with working memory and Adderall and similar medicines help to improve it. It appears that if your brain has normal function in this area, the Adderall makes it worse.

This makes sense. If your neurotransmitters are off, giving a medicine to stabilize them helps. If your neurotransmitters are at normal levels, giving a medicine that changes the levels hinders.

They also had elevations in their heart rate and blood pressure. If a student has an underlying heart condition, it could cause serious heart problems. This is one reason doctors ask about family and personal history before starting a patient on stimulant medications. If there is an increased risk, an ECG is recommended.

Without a physician monitoring the medication use, the risk goes up!

TL:DR

Stimulants have been proven to improve focus, attention, and working memory in people with ADHD.

When a physician prescribes stimulants, doses should be carefully titrated and routine follow up is required.

It is illegal to take stimulant medicines without a prescription.

Giving or selling prescription medicines to others is illegal.

If people take stimulants that are not prescribed to them or get them from a non-licensed pharmacy, they are at risk of getting fake drugs. Counterfeit drugs can lead to serious consequences.

When people without ADHD take stimulants, they may feel more focused, but their working memory is worse. This hinders their ability to perform well. They also suffer from physical risks without medical supervision.

When people with ADHD go without their medicines, their risks go up. Untreated ADHD is associated with early death. The risks are real if ADHD isn’t managed well!

Today we have so much information available to us through the internet, but you have to be very careful when you read it. Always remember to think critically when you read. Look at the source as well as the content. Don’t jump to conclusions – especially after just reading titles! A great read on this is An invisible unicorn has been grazing in my office for a month… Prove me wrong, so if you have the time, check it out!