New research that has been conducted indicates ADHD medication (called amphetamines) may stimulate psychosis or mania in the brain.
What is ADHD?
ADHD is a medical condition, which stands for attention deficit hyperactivity disorder. Someone with ADHD has differences in their brain development and brain activity that affects their attention span, ability to sit still, and self-control.
ADHD is a spectrum and can appear in different areas.
Low Attention Span: People with ADHD could have trouble focusing their attention, concentrating, and staying on task. Signs of this could be severe procrastination or frequent daydreaming.
Hyperactive: People with ADHD tend to be fidgety, restless, and easily bored. They may struggle to sit still or remain quiet when required. They might rush through tasks, often making careless mistakes. Without intending to, their behavior may sometimes disrupt others.
Impulsive: People with ADHD may act quickly without thinking things through. They may interrupt others, push or grab, and struggle with waiting. They might act without permission, take things that aren’t theirs, or engage in risky behaviors. Their emotional reactions can sometimes seem unusually intense for the situation.
Prominence of ADHD
An estimated seven million children between the ages of six to 17 have been diagnosed with ADHD in the United States as of 2022. Boys were diagnosed with ADHD more frequently than girls. Black and White children were diagnosed with ADHD more than Asian children. Similarly, American Indian/Alaska Native children were diagnosed with ADHD at a higher rate than Asian children.
An estimated six percent of adults have a current ADHD diagnosis, which is equivalent to one in 16, or approximately 15.5 million adults in the United States. Compared to adults who have never been diagnosed with ADHD, those currently diagnosed tend to be younger than 50 years old and have lower rates of holding a bachelor's degree or higher. Additionally they are less likely to identify as non-Hispanic Black or African American, are more likely to identify as non-Hispanic White, and have a greater likelihood of living in households with incomes below the federal poverty level.
How is ADHD Treated?
ADHD is often treated with either therapy and/or medication. There are two different types of medications.
Stimulants: Stimulants are the most common type of prescription medication used to treat ADHD. Stimulants work by increasing levels of certain chemicals in your brain called dopamine and norepinephrine. These chemicals are important for your ability to pay attention, think and stay motivated. However, these are controlled substances, which means they have the potential to be improperly used or cause substance use disorders. Due to this, some states have laws that tightly restrict the quantity of stimulant medications that you can receive at one time. Amphetamines are the likely drug to be prescribed. Some amphetamines are Adderall, Dexedrine, and Vyvanse.
Non-Stimulants: These are not controlled substances, which means they are not likely to be improperly used or cause substance use disorders. They work by increasing the levels of norepinephrine in your brain. Norepinephrine is important for helping you stay focused and alert.
Connection to Psychosis and Mania
Psychosis refers to a collection of symptoms that affect the mind, where there has been some loss of contact with reality, whereas mania is categorized by extremely unstable euphoric or irritable mood along with an excess activity or energy level, excessively rapid thought and speech, reckless behavior and feeling of invincibility.
In a study conducted by the American Journal of Psychiatry in September of 2024, it was found that high dose prescription amphetamines were linked to a 81% increase in a person’s risk of psychosis or mania. In this study 30 milligrams was considered a high dosage. It was also concluded that people taking any prescription amphetamine had a 63% higher risk of developing psychosis or mania.
"Stimulant medications don’t have an upper dose limit on their labels, and dose is a factor in psychosis risk and should be a chief consideration when prescribing stimulants," said Lauren Moran, a pharmacoepidemiology researcher at McLean Hospital, and lead author of this study.
She and her team emphasize in their paper, “There’s limited evidence that prescription amphetamines are more effective in high doses. Physicians should consider other medications our study found to be less risky, especially if a patient is at high risk for psychosis or mania”.
While stimulant medications like amphetamines can be effective for managing ADHD, recent research highlights the significant risks of the medication. This is especially true for the possible detrimental effects of the medication on brain health and mental stability. High doses of amphetamines are associated with an increase in the risk of psychosis and mania. This emphasizes the importance of careful dosage management and taking into consideration an individual’s mental health history and potential. Alternatives to high-dose stimulants may need to be taken, like non-stimulant medications. Safer options can be life-changing for patients with a higher vulnerability to mental health issues.
This study can hopefully encourage healthcare providers to balance symptom management, while still minimizing its adverse effects.
Sources and Further Reading