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Newly prescribed ADHD medications may cause psychosis, study finds

Adderall and Vyvanse can increase risk of psychosis, study finds

Certain medications used to treat ADHD in teens and young adults may be more likely to cause symptoms such as paranoia, hallucinations, delusions and hearing voices, a new study suggests.

Researchers found that patients who had been newly prescribed amphetamines, such as Adderall and Vyvanse, were more likely to develop psychosis than those who had received a prescription for methylphenidates, such as Ritalin and Concerta, according to the study published Wednesday by the New England Journal of Medicine.

While psychosis with either class of medication is still relatively rare — occurring at a rate of one in 660 patients — experts cautioned that patients should know about the increased risk.

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They also noted that the increased risk was only for those who recently began treatment with a new amphetamine prescription for ADHD and that those who have taken the drug and tolerated it well should not be concerned.

“If someone has been on Adderall, they’re tolerating it well, it’s helpful for their symptoms, and they’re taking it as prescribed, there’s really not much cause for concern,” said the study’s lead author, Dr. Lauren Moran, an assistant professor at the Harvard Medical School and a psychiatrist at McLean Hospital.

“Still you have to think about it from the public health scale,” Moran added. “If it’s a fraction of a percent of millions of people then that means there could be thousands of additional cases of psychosis across the United States. In my mind that’s a serious problem.”

Amphetamine prescriptions to treat ADHD have been steadily rising, increasing cause for concern.

“At the beginning of our study, in 2005, a patient had about a 50-50 chance of getting Adderall or Ritalin. There has been a huge increase in Adderall prescriptions over the course of the study to almost four times as many prescriptions for Adderall,” Moran said.

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As the number of students with psychosis grew, Moran decided to look further into the issue. What she found was that a common factor among the cases seemed to be amphetamine prescriptions for ADHD.

To determine whether there really was a higher risk of psychosis associated with amphetamines, Moran and her colleagues turned to two large commercial insurance claims databases, which included more than 5 million patients with a stimulant prescription.

The researchers focused on patients 13 to 25 years old who started taking either amphetamines or methylphenidates from Jan. 1, 2004, to Sept. 30, 2015. Among more than 221,846 patients included in the study, 110,923 were taking methylphenidate and 110,923 were taking amphetamines. The study focused only on new users of the medication.

New cases of psychosis were identified in 106 of the patients taking methylphenidate, as compared to 237 in those taking amphetamines, nearly double the rate.

The Food and Drug Administration has been aware of the issue of psychosis. In fact, in 2007 the federal agency mandated that ADHD medication labels include warnings about potential psychiatric and heart issues.

In Moran’s experience, ADHD patients hospitalized for psychosis recovered in two weeks on average, but some patients took as long as two months.

Moran isn’t suggesting that ADHD medications are too dangerous to be prescribed, but wants to inform patients about its use.

“We’re trying to raise awareness,” she said. “Physicians need to be aware of this when prescribing, and people who are getting these medications from friends in college need to know this is a risk.”

Experts interviewed by NBC News agreed that there should be greater awareness of the risks associated with these medications.

The new study emphasizes the need for physicians to be “extremely careful to diagnose ADHD appropriately and to provide appropriate treatment,” said Dr. Antoine Douaihy, a professor of psychiatry and medicine at the University of Pittsburgh School of Medicine and senior academic director of Addiction Medicine Services at the University of Pittsburgh Medical Center. “And they need to monitor patients closely so they can identify early signs of behavioral changes related to psychotic or manic symptoms.”

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While the study shows that psychosis is a risk for both stimulants, it does suggest that amphetamines “may be more implicated than methylphenidates,” said Dr. David Goodman, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and director of the Adult Attention Deficit Disorder Center of Maryland. A limitation of the study is that the databases used by the researchers don’t have detailed information on how patients were diagnosed, Goodman said.

Goodman hopes that the study, and the coverage it gets, will make doctors and patients treat these medications with care. But he hopes all the attention won’t scare patients away from ADHD drugs.

“Left untreated, ADHD has so many negative consequences,” Goodman said.

Linda Carroll is a regular health contributor to NBC News and Reuters Health. She is coauthor of “The Concussion Crisis: Anatomy of a Silent Epidemic” and “Out of the Clouds: The Unlikely Horseman and the Unwanted Colt Who Conquered the Sport of Kings.”

Two common ADHD medications, Adderall and Vyvanse, used in teens and young adults may be more likely to cause psychosis, according to a new study.

Vyvanse

GENERIC NAME(S): Lisdexamfetamine

OTHER NAME(S): Vyvanse Capsule

Misuse or abuse of amphetamines may cause serious (possibly fatal) heart and blood pressure problems. Amphetamine-type medications can be habit-forming. Use only as directed. If you use this drug for a long time, you may become dependent on it and may have withdrawal symptoms after stopping the drug. Consult your doctor or pharmacist for more details. (See also How to Use section.

  • Uses
  • Side Effects
  • Precautions
  • Interactions
  • Overdose
  • Images
  • Uses
  • Side Effects
  • Precautions
  • Interactions
  • Overdose
  • Images

Lisdexamfetamine is used to treat attention deficit hyperactivity disorder (ADHD) as part of a total treatment plan, including psychological, social, and other treatments. It may help to increase the ability to pay attention, stay focused, and stop fidgeting. Lisdexamfetamine may also be used to treat binge eating disorder (BED). It may help to reduce the number of binge eating days.

This medication is a stimulant. It is thought to work by restoring the balance of certain natural chemicals (neurotransmitters) in the brain.

This medication is not recommended for use for weight loss due to the risk of serious side effects.

How to use Vyvanse

Read the Medication Guide provided by your pharmacist before you start taking lisdexamfetamine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication with or without food as directed by your doctor, usually once daily in the morning. Do not take this medication in the afternoon or evening because it may cause you to have trouble sleeping. The dosage is based on your medical condition and response to treatment. Your doctor may adjust your dose to find the dose that is best for you. Follow your doctor’s instructions carefully.

If you are taking the chewable tablet, chew the tablet thoroughly and then swallow.

If you are taking the capsule form of this medication, swallow the capsule whole. However, if you have trouble swallowing the capsule, you may open the capsule and pour all of its contents (powder) in a glass of water or orange juice or mix it in yogurt. Use a spoon to break apart any powder that is stuck together. Stir well until the contents dissolve completely. Drink or eat the mixture right away. Do not prepare a supply in advance. It is normal to see a filmy coating on the inside of your glass or container after you drink or eat all of the medicine.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.

During treatment, your doctor may occasionally recommend stopping the medication for a short time to see whether there are any changes in your behavior and whether the medication is still needed.

If you suddenly stop using this medication, you may have withdrawal symptoms (such as severe tiredness, sleep problems, mental/mood changes such as depression). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used lisdexamfetamine for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.

Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Do not increase your dose, take it more often, or use it for a longer time than prescribed. Properly stop the medication when so directed.

When this medication is used for a long time, it may not work as well. Talk with your doctor if this medication stops working well.

Tell your doctor if your condition does not improve or if it worsens.

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Side Effects

Nausea, vomiting, constipation, stomach/abdominal pain, loss of appetite, dry mouth, headache, nervousness, dizziness, trouble sleeping, sweating, weight loss, irritability, and restlessness may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medicine because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

Tell your doctor right away if you have any serious side effects, including: blurred vision, fast/pounding/irregular heartbeat, mental/mood/behavior changes (such as agitation, aggression, mood swings, depression, hallucinations, abnormal thoughts/behavior, suicidal thoughts/attempts), uncontrolled movements, muscle twitching/shaking, signs of blood flow problems in the fingers or toes (such as coldness, numbness, pain, or skin color changes), unusual wounds on the fingers or toes, outbursts of words/sounds, change in sexual ability/interest, swelling ankles/feet, extreme tiredness, rapid/unexplained weight loss, frequent/prolonged erections (in males).

Get medical help right away if you have any very serious side effects, including: shortness of breath, fainting, chest/jaw/left arm pain, seizures, weakness on one side of the body, trouble speaking, confusion, sudden vision changes.

This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

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Precautions

Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or to other sympathomimetic drugs (such as amphetamine or dextroamphetamine); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: blood circulation problems (such as Raynaud’s disease), certain mental/mood conditions (such as severe agitation, psychosis), personal/family history of mental/mood disorders (such as bipolar disorder, depression, psychotic disorder, suicidal thoughts), heart problems (including irregular heartbeat, coronary artery disease, previous heart attack, heart failure, cardiomyopathy, problems with heart structure such as valve problems), family history of heart problems (such as sudden death, irregular heartbeat), history of stroke, high blood pressure, overactive thyroid (hyperthyroidism), a certain eye problem (glaucoma), seizures, kidney disease, personal or family history of a substance use disorder (such as overuse of or addiction to drugs/alcohol), personal/family history of uncontrolled muscle movements (such as Tourette’s syndrome).

This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Children may be more sensitive to the side effects of this drug, especially weight loss. This medication may slow down a child’s growth. The doctor may recommend temporarily stopping the medication from time to time to reduce this risk. Monitor your child’s weight and height. Consult your doctor or pharmacist for more details.

During pregnancy, this medication should be used only if clearly needed. Discuss the risks and benefits with your doctor. Infants born to mothers who are dependent on this medication may be born too soon (premature) and have low birth weight. They may also have withdrawal symptoms. Tell your doctor right away if you notice possible mood changes, agitation, or unusual tiredness in your newborn.

This medication passes into breast milk and may have undesirable effects on a nursing infant. Therefore, breast-feeding is not recommended while using this drug. Consult your doctor before breast-feeding.

Find patient medical information for Vyvanse Oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings.