But there isn't there are no clear guidelines on maximum dosesand the number of young adults using the drug has increased since the Covid-19 pandemic, largely as part of the rise of telemedicine. The study was conducted by a team led by psychiatrist Lauren Moran from Mass General Brigham Hospital in Boston. His interest in the subject came early in his career after seeing many university students consulted.
Analysis of medical records
“I was seeing a lot of people who come in without much of a psychiatric history and develop a first episode of psychosis or mania in the context of stimulant use,” she explained. When the US Food and Drug Administration (FDA) learned of these cases in the 2000s, it added a warning to the drug's label. But relatively little research has been done to quantify the rates of side effects or their relationship to dose.
Lauren Moran and her colleagues analyzed the medical records of people ages 16 to 35 admitted to Mass General Brigham Hospitals between 2005 and 2019. This is the typical age of onset of psychosis. The researchers identified 1,374 people experiencing a first episode of psychosis or mania and compared them with 2,748 patients hospitalized for other psychiatric disorders.
By looking at Adderall use in the previous month and taking into account other variables, such as drug use, they were able to specifically determine the impact of stimulants. They found that people who took Adderall were 2.68 times more likely to have been hospitalized for psychosis or mania than those who didn't — and that likelihood rose to 5.28 times for higher doses (40 milligrams and above).
telemedicine
A separate analysis found no increased risk with Ritalin, another stimulant prescribed for ADHD. According to Lauren Moran, this could be due to differences in the way these two drugs work. Both increase levels of dopamine, which is involved in motivation and learning. However, while Adderall, an amphetamine, increases the release of dopamine, Ritalin works by blocking its reabsorption.
For Lauren Moran, the study demonstrates the need to clearly state maximum doses on labels. The latter currently recommend treating patients with 20 milligrams, but in practice, doctors prescribe doses that vary widely. This is partly because more advanced ADHD symptoms require a higher dose. But the researcher sometimes observed “negligence in prescriptions.” Patients may also be able to find a doctor willing to prescribe the desired dose.