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Teens and young adults with Attention Deficit Hyperactivity Disorder (ADHD) who take stimulant medications have a low risk of developing psychosis – a fact already reported by drug labels.
Adding to this, a new study showed that this risk was higher among 13-25 year olds, whose amphetamines such as Vyvanse and Adderall, had taken amphetamines, compared to those who received methylphenidates such as Ritalin or Concerta. .
Experts point out that people taking drugs and parents should not be alarmed by the results The overall risk was low, affecting about 1 in 660 patients, according to the study published this week in the New England Journal of Medicine.
"Although the risk of psychosis badociated with treatment of ADHD with a stimulant drug may worry patients, it should be remembered that it was a very rare side effect," said the Dr. Andrew Adesman, Head of the Pediatric Development and Behavior Department of Steven & Alexandra Cohen. New York Children's Medical Center in New Hyde Park, New York.
The researchers used two national insurance claim databases to track 221,846 adolescents and young adults with ADHD who started taking a stimulant drug between 2004 and 2015.
Amphetamines were prescribed half by their doctor and the other half with methylphenidates.
Patients who had received amphetamine had a 0.21% chance of having a psychotic episode within a few months of starting treatment. For those who received methylphenidate, it was 0.1%.
"Among the stimulant drugs, methylphenidate seems less badociated with a new psychosis than amphetamine," said Dr. Michael Brodsky, medical director of behavioral health at L.A. Care Health Plan.
For the study, the researchers considered a psychotic episode as a new diagnosis of psychosis and a prescription for an antipsychotic drug.
The researchers followed the patients for several months after starting ADHD treatment.
But Adesman said, "It's unclear to what extent there is a permanent risk of developing psychosis if a patient takes stimulant medications for several years without any problems."
is a developmental disorder that is usually diagnosed in childhood and often continues into adulthood. People with this condition may have difficulty paying attention, acting without thinking or being too active.
The disease is often treated with a combination of behavioral therapy and medications.
Brodsky said: "Stimulant medications are the most effective treatment for ADHD", although "they have a low risk of increasing the risk of psychosis."
Some found that the use of methylphenidate and amphetamine to treat ADHD in adolescents and young adults is increasing.
Adesman pointed out that the study was only about psychosis. This involves disruptions in a person's thoughts and perceptions that prevent them from knowing what is real.
The side effects of stimulant medications for ADHD are "transient hallucinations," which researchers have not studied.
Dr. James Lewis, professor of pediatrics at the Joan C. Edwards School of Medicine at Marshall University in Huntington, West Virginia, said children with this side effect may "cry uncontrollably, see spiders or insects on their skin, become anxious cars pbading by, or see a large green frog in their closet. "
He added, "But this is a very rare experience and the symptoms disappeared when the treatment was stopped."
Lewis, the author of "Giving Meaning to ADHD: Overcoming the Challenges of Coexistence," also pointed out that the study did not include children under age 13, or people with public insurance or no insurance. The results may not apply to these groups.
The authors write in the article that differences in psychosis rates may be due to differences in the functioning of drugs in the brain.
Both drugs stimulate the release of dopamine from the brain by neurons. They also prevent dopamine from being removed from the synapses, the spaces between the ends of the neurons.
The amphetamine causes the release of more dopamine, causing a rise in power. Methylphenidate blocks the elimination of dopamine better, which makes it stay longer.
Changes in the way neurons transmit signals during a psychosis are more like what happens after the use of amphetamine, the researchers write.
Some experts fear that this study will worry parents and deter them from using drugs to treat their child's ADHD.
Many medical decisions, however, are about balancing risks and benefits.
Children whose ADHD is not treated can continue to have academic, social and emotional difficulties throughout their childhood and even into adulthood.
There is also a balance between the risks badociated with different drugs.
Adesman said: "Given these findings, some patients might feel more comfortable in the future to be treated with a formulation of methylphenidate instead of amphetamines."
"The reality is that some patients may reap more benefits from an amphetamine formulation than from a methylphenidate formulation," he added.
Lewis pointed out that the rate of psychosis is extremely low, even though there is an increased risk for people taking amphetamines.
"However, parents should receive this information in order to be aware of the possibility and determine which drug they prefer," said Lewis.
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