Prescription Drug Linked to Psychosis Risk

A new study has revealed that teens and young adults who are prescribed high doses of pharmaceutical amphetamines have a five times greater chance of developing psychosis. Those at the greatest risk are on doses of ≥ 30 mg of dextroamphetamine, which is the equivalent of 40 mg of Adderall. However, they did not find any link between new-onset psychosis and past-moth intake of Ritalin. 

What is Amphetamine?

Amphetamine belongs to a group of drugs known as stimulants. Stimulants can be legally prescribed for many medical uses, including dealing with obesity and ADHD. They are known to cause effects such as increased physical activity and higher mental alertness. Many people also purchase amphetamine on the black market, however, this is very dangerous. Yet, even using legally prescribed amphetamines can present serious problems, such as mania and psychosis. [1]

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Lack of Upper Dose Limits

A major concern is that stimulant medications lack upper dose limits on the labels. Dosage is a large factor where psychosis is concerned and should be carefully considered when stimulants are prescribed to patients. While it may be a rare side effect, it is a very serious one and should therefore be monitored by both doctor and patient in the case that stimulants are prescribed. Other long-term effects of stimulant use include an irregular heart rate, insomnia, increased blood pressure, and even heart failure. [2] However, prescription stimulants are generally safe if taken at the recommended dosages. 

The Study on Amphetamine Dosage

While previous studies have highlighted the link between prescription amphetamines and psychosis, there is still very limited information on the impact of high doses. In fact, there is a major gap in our understanding of how high dosages affect people in the long term. In order to learn more about this connection, Dr. Lauren Moran from McLean Hospital in Belmont, Massachusetts, conducted a study using the records of patient encounters at Mass General Brigham between 2005 and 2019. They specifically focused on the typical age of psychosis onset, which is from 16 to 35 years of age. [3]

Results of the Study

The researchers identified just over 1370 case patients who had displayed a first psychosis episode. Overall, they reported a higher than twofold increase in psychosis risk among people with past-month prescription use. The likelihood of developing psychosis with past-month prescription use increased by 5.3 times when doses of dextroamphetamine exceeded 30 mg. The analysis revealed that people were 13.5 times more likely to experience psychosis when taking the highest dosage, compared to the outpatients controls. [3]

Potential Strategies for Mitigating Risks

The researchers of the study pointed out that the current guidelines for treating ADHD don’t specify maximum doses. So, they advise that doctors adjust the dose based on symptom control while avoiding serious side effects. Their findings suggest that doctors can potentially mitigate psychosis risk by staying under doses of 30mg of dextroamphetamine. While the data gathered from the study provided useful dosage guidelines, the majority of the participants did not have ADHD. This means that they still do not know how this data would apply to individuals who have this condition. [3]

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Issues with the Study on Amphetamines

The fact that most of the participants did not have ADHD was only one issue with the study. Another problem was that they were not able to tell if the stimulants were being used in the doses that they had been prescribed. Very often, patients abused their prescribed stimulates, which could account for a considerable percentage of the results. [4] The researchers also warned that because it was an observational study, there were bound to be inaccuracies in the data. While the researchers did their best to adjust for potentially confounding factors, they couldn’t do so for all of them. This is because they did not have access to data such as a patient’s prior psychiatric disorders. 

Further Insights 

Several doctors have weighed in with their opinions about the study. Certain doctors, such as Dr. Kraguljac from the Ohio State University College of Medicine in Columbus, feel that the authors did a great job of defining the research’s limitations. Her main takeaway was that clinicians need to be more mindful when prescribing high dosages of amphetamines to younger adults and teens. Especially in those situations where there is a family history of serious mental illnesses, such as psychosis. In these cases, they recommend that people try alternatives, such as Ritalin. 

The Bottom Line on Amphetamine Prescriptions

There is no denying the fact there are many practical reasons for being prescribed stimulants such as amphetamines. However, these medications often come with unwanted and dangerous side effects. This is especially true when it comes to taking high doses or abusing the substances. As studies have highlighted, taking large doses can lead to serious side effects, such as mania and psychosis. To avoid these dangerous side effects, it is always best to make sure that you are not taking more than you have been prescribed. 

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