Research from McLean Hospital in Boston and Harvard Medical School has shown that certain drugs prescribed for ADHD teenagers and young adults can increase their risk of developing psychosis. These drugs are prescribed for ADHD treatment to approximately 5 million Americans under 25.
The researchers compared two of the most popular ADHD treatments and found that while the risk of psychosis was low, it was higher for patients who were taking Adderall and Vyvanse than for those who were taking methylphenidates (marketed by Ritalin or Concerta).
“The findings are alarming because amphetamine use in adolescents and young adults has more that tripled in recent decades,” said Lauren V. Moran, MD, lead author of the paper. These medications are being used more frequently,” Lauren V. Moran MD, researcher, was the lead author of the paper published in the journal. New England Journal of MedicineApril 21, 2019
Moran said that there is not much research on comparing the safety profiles for amphetamines with methylphenidate. However, clinicians have long observed patients without a history of psychiatric disorders becoming psychotic in the context of stimulant use.
The study analyzed data from two large commercial insurance databases that included information on ADHD patients aged 13-25 who began taking amphetamines and methylphenidate between September 30, 2015, and January 1, 2004. The researchers looked at 221,846 patients and found that one in four of them had developed psychosis from taking an amphetamine or methylphenidate between January 1, 2004 and September 30, 2015. This was compared to the 1 in 1,046 who took a methylphenidate.
Moran insists that even though there is an increased risk, the study was limited only to those who had been diagnosed with ADHD recently and started treatment. Moran said that people who have been using Adderall for some time and are able to tolerate it well, are unlikely to experience this problem.
The National Institutes of Health funded the study under award number K23MH110564. The study analysed data from commercial insurance claims using the Aetion Evidence PlatformTM. The Aetion platform generates regulatory-grade evidence quickly using real-world data. The FDA is using it in its ongoing demonstration of real-world evidence.
This is the first time that this type of analysis has been performed with data from routine patient care, rather than clinical trial data. This data is more likely to reflect treatment patterns in large, diverse populations than the uniform care given in controlled research trials. These results are therefore more likely be applicable to a wider range of patients.
Sebastian Schneeweiss, MD. ScD, a Harvard Medical School professor and co-founder of Aetion, said that he had analyzed two large insurance claim databases to determine the risk to patients who take amphetamines to treat ADHD. “The study highlights the importance of using data from real patients to better understand the safety of commonly prescribed medication and allows physicians to weigh the risks and benefits.”
The published research paper, “Psychosis with Amphetamine or Methylphenidate in Attention Deficit Disorder,” was co-authored by Moran, who is psychiatrist in charge at McLean’s Schizophrenia and Bipolar Disorder Inpatient Program and Schizophrenia and Bipolar Disorder Research Program, along with Dost Öngür, MD, PhD, John Hsu, MD, MBA, MSCE, Victor M. Castro, M.S., Roy H. Perlis, MD, MSc, and Sebastian Schneeweiss, MD, ScD.
Materials provided by McLean Hospital. Note: Content can be edited for style or length.