SALT LAKE CITY (KUTV) — Adderall, along with other amphetamines used to treat ADHD, is linked to a greater chance of psychosis than other medications used to treat the disorder, a new study finds.
Psychosis is a group of symptoms which includes delusions, hallucinations, and a loss of touch with reality.
The study, published in The New England Journal of Medicine, found there were more new-onset cases of psychosis from amphetamines like Adderall than methylphenidate drugs like Ritalin.
While the risk is greater, it's important to note that new-onset diagnoses of psychosis are still rare, occurring in 0.1 percent of all patients analyzed in the study.
Researchers combed insurance databases to assess 337,919 patients aged 13-25 who received a prescription for a stimulant for ADHD between January 1, 2004, and September 30, 2015.
The study says:
The outcome was a new diagnosis of psychosis for which an antipsychotic medication was prescribed during the first 60 days after the date of the onset of psychosis.
The study eventually compared110,923 patients taking methylphenidate (like Ritalin) with 110,923 patients taking amphetamines (like Adderall).
There were 106 episodes of psychosis (0.10%) in the methylphenidate group and 237 episodes (0.21%) in the amphetamine group.
An episode of psychosis was defined as "a new diagnosis code for psychosis and a prescription for an antipsychotic medication."
Dr. Lauren V. Moran, a psychiatrist and assistant professor at Harvard Medical School told the website Inverse.com:
We see people who were prescribed the medication developing psychosis, but we also see people who are abusing it getting psychosis as well. There are so many college students around here, and we’ve been seeing patients come in who are developing a first episode of psychosis in the context of stimulant use — more often, amphetamines.
The study was supported by grants from the National Institute of Mental Health.
Information before the study began was provided as background on the study's website:
The prescription use of the stimulants methylphenidate and amphetamine for the treatment of attention deficit–hyperactivity disorder (ADHD) has been increasing. In 2007, the Food and Drug Administration mandated changes to drug labels for stimulants on the basis of findings of new-onset psychosis. Whether the risk of psychosis in adolescents and young adults with ADHD differs among various stimulants has not been extensively studied.
Below are the methods used by the study:
We used data from two commercial insurance claims databases to assess patients 13 to 25 years of age who had received a diagnosis of ADHD and who started taking methylphenidate or amphetamine between January 1, 2004, and September 30, 2015. The outcome was a new diagnosis of psychosis for which an antipsychotic medication was prescribed during the first 60 days after the date of the onset of psychosis. To estimate hazard ratios for psychosis, we used propensity scores to match patients who received methylphenidate with patients who received amphetamine in each database, compared the incidence of psychosis between the two stimulant groups, and then pooled the results across the two databases.
The results, as stated in the study say:
We assessed 337,919 adolescents and young adults who received a prescription for a stimulant for ADHD. The study population consisted of 221,846 patients with 143,286 person-years of follow up; 110,923 patients taking methylphenidate were matched with 110,923 patients taking amphetamines. There were 343 episodes of psychosis (with an episode defined as a new diagnosis code for psychosis and a prescription for an antipsychotic medication) in the matched populations (2.4 per 1000 person-years): 106 episodes (0.10%) in the methylphenidate group and 237 episodes (0.21%) in the amphetamine group (hazard ratio with amphetamine use, 1.65; 95% confidence interval, 1.31 to 2.09).
Researchers arrived at the following conclusions:
Among adolescents and young adults with ADHD who were receiving prescription stimulants, new-onset psychosis occurred in approximately 1 in 660 patients. Amphetamine use was associated with a greater risk of psychosis than methylphenidate. (Funded by the National Institute of Mental Health and others.)
The study was published March 21, 2019.
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