Adolescents face a lot of challenges. As a result, many have received treatment for anxiety, depression, attention deficit disorder, PTSD or other mental health problems. Consequently, many are taking prescriptions to address the symptoms. Increasingly, doctors are prescribing multiple medications. A new study published in the American Journal of Psychiatry (Sept. 12, 2024) reveals the hidden dangers of ADHD meds like Adderall (mixed amphetamines). Another study in BMC Primary Care (July 30, 2024) exposes the perils of combining psych drugs in children, adolescents and young adults.
Adderall and the Risk of Psychosis: Hidden Dangers of ADHD Drugs
Many people have no idea what is in Adderall. All they know is that it is prescribed for attention deficit hyperactivity disorder (ADHD) and narcolepsy. Some may not realize that the ingredients in Adderall are dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate and amphetamine sulfate. In other words, Adderall is a mixture of amphetamine-type stimulants.
We fear that health care professionals and parents may underestimate the hidden dangers of ADHD prescribed medications. We suspect that parents have a hard time imagining that they could be giving their kids medications that could cause serious psychological side effects. Somehow the dangers of amphetamine-type drugs seem less serious when the medicine has a name like Adderall or Vyvanse (lisdexamfetamine).
If you look at the official prescribing information for Adderall and its generic equivalents you will see that there is a boxed warning. The FDA is worried about “abuse and misuse.” What you won’t see in the black box warning is any mention of psychosis.
If you dig a bit deeper, though, you will discover that under the heading
WARNINGS there is this:
Psychiatric Adverse Reactions
“CNS [central nervous system] stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a pre-existing psychotic disorder.
“CNS stimulants, at recommended doses, may cause psychotic or manic symptoms (e.g., hallucinations, delusional thinking, or mania) in patients without a prior history of psychotic illness or mania.”
Under the category ADVERSE REACTIONS there is this:
“Psychotic episodes at recommended doses, overstimulation, restlessness, irritability, euphoria, dyskinesia [involuntary body movements], dysphoria [deep unhappiness], depression, tremor, motor and verbal tics, aggression, anger, logorrhea [inability to stop talking], dermatillomania [compulsive skin picking or scratching].”
Research Reveals the Hidden Danger of ADHD Medications:
The study published in the American Journal of Psychiatry (Sept. 12, 2024) is titled:
“Risk of Incident Psychosis and Mania With Prescription Amphetamines”
Here is what the researchers discovered:
“This case-control study identified an increased odds of incident psychosis or mania with prescription amphetamine use, where increasing dose levels of prescription amphetamines were associated with higher risk. The odds of psychosis or mania with past-month prescription amphetamine use were increased by 5.3 times with doses exceeding 30 mg dextroamphetamine equivalents, which corresponds to 40 mg of mixed amphetamine salts and 100 mg of lisdexamfetamine. In sensitivity analyses comparing case subjects with outpatient control subjects, the odds of psychosis or mania were increased by 13.5 times with the highest dose level. The finding of an increased risk of psychosis with prescription amphetamines compared with methylphenidate [Ritalin] is consistent with results from a large cohort study.”
The numbers described above suggest that high doses of Adderall (more than 40 mg) or 100 mg of lisdexamfetamine [Vyvanse] increases the risk for psychosis. Methylphenidate (Ritalin or Concerta) did not appear to increase the risk for such a serious mental health challenge.
When Psych Drugs Are Mixed and Matched:
An analysis of data from more than 2 million New York State Medicaid recipients under 21 showed that almost 6% received what the authors called “behavioral and mental health (BMH) medications” (BMC Primary Care (July 30, 2024)). What were some of the drugs in question?
They included:
- Dextroamphetamine/amphetamine
- Clonidine
- Risperidone
- Sertraline
- Fluoxetine
- Lisdexamfetamine
- Diazepam
- Citalopram
- Trazodone
- Bupropion
- Clonazepam
- Lithium
The authors of this research were concerned about “polypharmacy.” That’s when two or more different kinds of psych drugs are prescribed. They described this situation as “contraindicated drug pairs (CDPs).” In other words, these were medications that shouldn’t have been combined!
Here are some of the problems the researchers encountered:
About one third of the youngsters who received a prescription for the antipsychotic drug Geodon (ziprasidone) also got a prescription for a psych drug that was “contraindicated.” That means it was inappropriate. That is damn scary.
Geodon is an antipsychotic medication. That it was prescribed together with inappropriate medications (that means a “contraindicated partner” drug) so frequently is alarming.
Antidepressants such as Prozac (fluoxetine) or Desyrel (trazodone) were sometimes added to antipsychotic medications. That could lead to dangerous heart rhythm disturbances, or something called serotonin syndrome. You can read about that dangerous reaction at this link.
The authors conclude:
“We found that nearly 6% of children, adolescents, and young adults filled a BMH [behavioral and mental health ] medication and 392 were dispensed a contraindicated combination.”
The bottom line seems to be that some children are being prescribed worrisome combinations of mental health drugs. The hidden dangers of ADHD medications are likely to go up when they are also combined with other psych drugs.
Parents must be vigilant when giving a child any medication, especially if it is for behavioral and mental health reasons.
