Whoa! Could this explain a lot of the school shooters? Or partially?

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By Lily Anderson

The Hidden Risks of High-Dose ADHD Medications: Psychosis and Mania

In recent years, amphetamines, commonly prescribed for ADHD and other conditions like narcolepsy, have come under increased scrutiny. Research highlights a concerning connection between high doses of these medications and the risk of developing psychosis or mania. While many people rely on amphetamines for daily focus and productivity, it’s important to understand the potential side effects that may accompany their use, particularly when taken in higher doses.

Understanding the Connection Between ADHD Medications and Psychosis

Amphetamines work by stimulating the central nervous system, helping people with ADHD stay focused and alert. However, their powerful effects on brain chemistry—particularly neurotransmitters like dopamine—may also be linked to serious psychiatric side effects, including psychosis and mania.

According to a case-control study conducted by McLean Hospital researchers, individuals taking high doses of amphetamines have a significantly increased risk of developing psychosis or mania. Dr. Lauren Moran, a pharmacoepidemiology researcher and lead author of the study, stated that “stimulant medications don’t have an upper dose limit on their labels, and our results show that it is clear that dose is a factor in psychosis risk and should be a chief consideration when prescribing stimulants.”
The Statistics: How High is the Risk?

The study, which analyzed medical data from over 1,300 individuals hospitalized for their first episode of psychosis or mania, revealed alarming trends. People who had taken amphetamines in the past month were 2.68 times more likely to experience psychosis or mania compared to those who hadn’t used the medication.

Even more concerning, the risk increases with the dosage. Individuals on high doses of amphetamines—considered over 30 mg of dextroamphetamine equivalents—were found to have a 5.28-fold increased risk of psychosis or mania compared to those not on the medication. The risk of developing these conditions increased by 81% for those taking the highest doses.

This information is particularly concerning given the rise in prescription amphetamine use in the United States, which saw a 70% increase from 2011 to 2021.

Amphetamines vs. Methylphenidate: A Safer Alternative?

Interestingly, the same study found no significant increase in the risk of psychosis or mania among individuals who were prescribed methylphenidate (commonly known by the brand name Ritalin), which is another stimulant often used to treat ADHD. Dr. Moran’s research in 2019 also supported this finding, suggesting that “other medications our study found to be less risky” should be considered, especially for individuals at a higher risk of developing psychiatric conditions.

What Does This Mean for People Taking ADHD Medications?

While amphetamines have proven to be effective for treating ADHD, this research highlights the importance of closely monitoring patients—especially those on higher doses. Dr. David Merrill, a geriatric psychiatrist, emphasized that “the association of high-dose amphetamine use with an increased risk of psychosis or mania reminds us of the need for careful patient selection, dose titration, and close monitoring.”

He recommends using the lowest effective dose and exploring non-pharmacological treatments like therapy, mindfulness practices, and lifestyle changes. Engaging in regular mental health evaluations is essential to assess any potential side effects or emerging risks.

Is There a Causal Relationship?

Though the study strongly suggests a link between high-dose amphetamine use and the risk of psychosis, more research is needed to determine whether this is a causal relationship. Stacy Doumas, MD, chairwoman of Psychiatry at Hackensack Meridian Jersey Shore University Medical Center, stated that “given the activity of amphetamines on the neurotransmitters in the brain, such as dopamine, which are also related to psychosis, there are potential mechanisms to explain this.” She emphasized that further studies should examine these mechanisms better to understand the relationship between amphetamines and psychiatric disorders.

Conclusion: Proceed With Caution

If you or a loved one is taking amphetamines, it’s essential to have open discussions with your healthcare provider about the risks and benefits, as well as regularly monitor mental health during treatment. Lower doses and alternatives like methylphenidate may offer a safer option for some patients.

By understanding the potential risks and carefully considering your treatment options, you can make informed decisions that will support your long-term well-being.

Article Sources:

McLean Hospital Study, American Journal of Psychiatry, 2024 – https://doi.org/10.1176/appi.ajp.20230329

Medical News Today, “High-dose ADHD drugs linked to 81% higher psychosis risk, study warns” – https://www.medicalnewstoday.com/

About the Author

Lily Anderson is an enthusiastic writer and curious investigator of the latest scientific developments. Driven by a strong desire to learn, she has a knack for simplifying complex concepts into engaging stories, making science accessible and interesting to a broad audience. Lily’s work is important for connecting specialists with the general public, sparking wonder, and fostering meaningful conversations about new scientific discoveries.