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That is the typical onset age range for psychosis, or losing touch with reality.

The researchers identified 1,374 individuals experiencing their first episode of psychosis or mania — a disruptive state characterized by high energy, erratic behavior — and compared them to 2,748 control patients who were hospitalized for other psychiatric conditions. By analyzing Adderall use during the previous month and adjusting for other variables like substance use, they were able to specifically determine the impact of stimulants.

They found those who had taken Adderall were 2.68 times more likely to have been hospitalized with psychosis or mania compared to those who were not — and this increased to 5.28 times more likely at higher doses of 40 milligrams and above. Put another way, 81 percent of psychosis or mania cases may have been prevented if they were not on the high dose, the paper said. A separate analysis found no increased risk with Ritalin, another stimulant prescribed for ADHD. Moran suggested this could be due to key differences in how the two drugs work.

Both medications raise dopamine levels, a chemical messenger involved in the brain’s reward system, motivation and learning. However, while Adderall, an amphetamine, increases dopamine release, Ritalin works by blocking its reabsorption. For Moran, a critical takeaway was the need for clear upper dose limits on labels. The current label recommends treating patients with 20 milligrams, but in practice, doctors vary widely in their prescriptions.

This variability partly stems from severe impairment from ADHD symptoms that require higher doses, but Moran has occasionally observed “carelessness in dose prescribing,” while at other times, patients may “shop” for a doctor willing to prescribe what they want. “People, including clinicians, might think they can eliminate all ADHD symptoms, but that’s not a realistic expectation,” she added.

Telemedicine companies, in particular, have come under scrutiny for allegedly overprescribing Adderall, contributing to shortages for those who genuinely need the medication. The Drug Enforcement Administration, which had proposed revoking telehealth prescriptions for Adderall, extended them through the end of 2024 in response to significant public feedback. – AFP