The use of prescription amphetamines such as those used to treat ADHD has been linked to an increased risk of developing psychosis in past studies. Researchers at McLean Hospital have found that individuals who take high doses of amphetamines have a five-fold increased risk of developing psychosis or mania. Prescription amphetamine use in adults has been on the rise in the United States, with a 70% increase from 2011 to 2021, and a larger spike during the COVID-19 pandemic. Possible side effects of taking amphetamines include addiction, especially when used illegally as a recreational drug, and the development of psychosis which in some cases may lead to schizophrenia.
For their study, researchers analyzed data from adults aged 16 to 35 treated at Mass General Brigham between 2005 and 2019. They found that individuals receiving any prescription amphetamine had a 63% risk of developing psychosis or mania, which increased to 81% for those taking high doses considered to be 30 milligrams or more. Researchers also reported that there was no significant increase in psychosis risk for study participants receiving methylphenidate, commonly known as Ritalin. These findings suggest that 81% of psychosis or mania cases in people taking prescription amphetamines could have been eliminated if they were not taking a high dose.
Experts caution that the association of high-dose amphetamine use with an increased risk of psychosis or mania highlights the need for careful patient selection, dose titration, and close monitoring. They recommend using the lowest effective dose, initiating treatment with extended-release formulations to minimize peak plasma levels, and prioritizing nonpharmacologic interventions when possible. They also stress the importance of regular mental health evaluations and more frequent follow-ups, especially for patients with a history of psychosis, bipolar disorder, or other psychiatric vulnerabilities. Further research is needed to explore specific risk factors that predispose individuals to psychosis or mania when exposed to amphetamines, such as genetic markers, pre-existing mental health conditions, or concurrent use of other substances.
Experts suggest that future studies should investigate whether there is a causal relationship between high-dose amphetamine prescriptions and the risk of psychosis and mania. Longitudinal cohort studies, pharmacovigilance studies, and mechanistic studies can provide valuable information on the potential risks associated with the use of amphetamines. This research can help inform prescribing practices and improve the understanding of how amphetamines may impact mental health outcomes. Overall, the findings of this study underscore the importance of cautious and informed prescribing practices when it comes to amphetamine medications.
