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By Linda Carroll
A new study suggests that some medications used to treat ADHD in adolescents and young adults are more likely to cause symptoms such as paranoia, hallucinations, illusions and voices.
The researchers found that patients to whom new amphetamines, such as Adderall and Vyvanse were recently prescribed, were more likely to develop psychosis than those who received a prescription for methylphenidate, such as Ritalin and Concerta, according to the study. published Wednesday by the New England Journal of Medicine.
While psychosis associated with one or the other class of drugs is still relatively rare (occurring at a rate of one in 660), experts have warned that patients should be aware of the increased risk.
They also noted that the increased risk only concerned those who had just started treatment with a new amphetamine prescription for ADHD and that those who had taken it well and had tolerated it well did should not worry about it.
"If someone has already taken Adderall, he tolerates it well, it helps to relieve his symptoms, and he takes it as prescribed, there is really nothing to worry about", said the study's lead author, Dr. Lauren Moran, an assistant professor at Harvard Medical School and a psychiatrist at McLean Hospital.
"You still have to think about it at the public health level," added Moran. "If it's only a fraction of a million people, it means that there could be thousands of additional cases of psychosis in the United States." In my mind, this is a serious problem. "
The prescriptions of amphetamines to treat ADHD are steadily increasing, which raises some concern.
"At the beginning of our study, in 2005, a patient had about a 50% chance of getting an Adderall or Ritalin. During the study, the number of Adderall prescriptions dramatically increased to almost four times the number of prescriptions prescribed for Adderall, "said Moran.
As the number of students with psychosis increased, Moran decided to investigate the issue further. What she found, is that a common factor among the cases appeared to be the amphetamine prescriptions for ADHD, she said.
To determine whether the risk of amphetamine-related psychosis was actually higher, Moran and his colleagues turned to two large databases of commercial insurance claims, including more than 5 million patients with a stimulant prescription.
The researchers focused on patients aged 13 to 25 who had started taking amphetamines or methylphenidates from January 1, 2004 to September 30, 2015. Among more than 221,846 patients included in the study, 110,923 were taking methylphenidate and 110,923 used amphetamines. . The study is focused only on new users of the drug.
New cases of psychosis have been identified in 106 patients on methylphenidate, against 237 in those on amphetamines, which casts doubt on its rate.
The Food and Drug Administration is aware of the problem of psychosis. In fact, in 2007, the federal agency demanded that ADHD drug labels include warnings about potential psychiatric and cardiac problems.
According to the Moran experience, ADHD patients hospitalized for psychosis recovered in two weeks on average, but some patients took up to two months.
Moran does not suggest that drugs for ADHD are too dangerous to be prescribed, but wants to warn patients against its use.
"We are trying to raise awareness," she said. "Doctors should be aware of this when prescribing, and people who receive these drugs from friends of the university should know that it is a risk. "
Experts interviewed by NBC News agreed that there should be greater awareness of the risks associated with these drugs.
The new study underscores the need for physicians to be "extremely attentive to the diagnosis of ADHD and appropriate treatment," said Dr. Antoine Douaihy, a professor of psychiatry and medicine at the Faculty of Medicine at the University of Ottawa. University of Pittsburgh and Senior Academic Director of Addiction. Medical Services of the Medical Center of the University of Pittsburgh. "And they need to monitor patients closely so that they can identify early signs of behavioral changes related to psychotic or manic symptoms."
Although the study shows that psychosis is a risk for both stimulants, she suggests that amphetamines "may be more involved than methylphenidates," said Dr. David Goodman, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. Director of the Attention Deficit Disorder Treatment Center for Adults in Maryland. According to the study, the databases used by the researchers do not contain detailed information on the diagnosis of patients.
Goodman hopes that the study and the coverage it provides will lead physicians and patients to treat these drugs with care. But he hopes that any attention will not scare patients with ADHD medications.
"If we do not treat it, ADHD has so many negative consequences," said Goodman.
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