Prescribing high doses of Adderall may increase your patients' risk of psychosis by 5 times
Key Takeaways
Prescribing high doses of prescription amphetamines, like Adderall, may increase your patients’ risk of psychosis, according to a new study.
The study adds to existing research on prescription amphetamine use and psychosis risk, showing a connection between dosage and the extent of the risk.
To keep patients safe, doctors should prescribe the lowest effective dose of the medication to patients who need it. When treating patients already on high doses of the drugs, it is important to conduct mental health check-ins to look out for symptoms of psychosis.
People who take more than 40 milligrams of Adderall may be at increased risk of incident psychosis or mania, according to a new study.[] The study adds to research showing a link between prescription amphetamines and psychosis risks, now suggesting that the dose of amphetamines a person takes may correlate with their level of risk. The latest conclusion: the higher the dose you prescribe, the higher a patient’s risk for incident psychosis or mania.
“The current study highlights a greater understanding of the risk, particularly at higher doses,” says David Merrill, MD, PhD, a board-certified geriatric psychiatrist at Providence Saint John’s Health Center in Santa Monica, CA, and the Singleton Endowed Chair in Integrative Brain Health. “The extent of risk at specific dosage thresholds is becoming clearer.”
Dr. Merill adds that the study is a reminder for doctors to prioritize “careful patient selection, dose titration, and close monitoring” when prescribing—or working with patients who use—prescription amphetamines.
“This study prompts an immediate reconsideration of risk-benefit analysis in the prescribing process, particularly for patients with a history of mental health issues or those at high risk for psychosis,” he says.
Use and misuse of prescription amphetamines
Prescription amphetamines include drugs like Adderall, Dexedrine, and Vyvanse. They are commonly prescribed to treat conditions like attention-deficit hyperactivity disorder (ADHD), but can also be used illicitly as party drugs or as a “study drug” by people without ADHD.
In the study, researchers defined a high dose as more than 40 milligrams of Adderall, 100 milligrams of Vyvanse, and 30 milligrams of dextroamphetamine. psychosis or mania[]. Taking any of these drugs at high doses could increase risks of developing psychosis or mania by five times compared with those who aren’t taking the stimulants.
When it comes to prescribing these drugs for ADHD treatment, Dr. Merill says, it is important for doctors to be cautious when dosing and to individualize patients’ treatment plans.
“High doses should be prescribed only when absolutely necessary and after thorough evaluation of the patient's mental health history,” Dr. Merill adds.
But high doses can still be recommended to treat a person’s ADHD.
“Patients on 40 milligrams or higher doses of Adderall are typically those with severe ADHD symptoms that have not responded to lower doses,” Dr. Merill says.
If increasing a patient’s Adderall dose to 40 milligrams, doctors should prioritize mental health check-ins to look out for side effects and risk, he advises.
“Doctors should regularly reassess the need for such high doses and monitor for any signs of emerging psychosis,” Dr. Merill adds. Looking into alternative treatments, “like non-stimulant medications or combining lower doses with behavioral therapies along with regular mental health checkups,” may also help some patients stay on lower doses, he says.
When it comes to potential illegal uses of the drugs, Dr. Merill expresses additional concern. “Students who use Adderall without a prescription face significant risks, including psychosis, particularly at high doses or when combined with other substances,” he says.
What this means for you
A new study shows that higher doses of prescription amphetamines, such as Adderall, can contribute to an increased risk of psychosis and mania for users. To keep patients safe, it is important for doctors to be selective when prescribing Adderall, to utilize the lowest effective dose, and to conduct or encourage mental health check-ins for patients on the drug.