The use of prescription amphetamines to treat ADHD and narcolepsy has been linked to an increased risk of developing psychosis in past studies. Researchers from McLean Hospital have found that people who take high doses of amphetamines have a five-fold increased risk of developing psychosis or mania. Prescription amphetamine use has been on the rise in the United States, with a larger spike during the COVID-19 pandemic. Possible side effects of taking amphetamines include addiction, especially when used recreationally. The study found that 81% of psychosis or mania cases in people taking prescription amphetamines could have been eliminated if they were not taking a high dose.
The study conducted by researchers at McLean Hospital involved analyzing medical data from adults treated at Mass General Brigham between 2005 and 2019. They found that study participants receiving any prescription amphetamine had a 63% risk of developing psychosis or mania. This risk increased to 81% for those taking high doses of amphetamine, considered to be 30 milligrams or more. The study also showed no significant increase in psychosis or mania risk in participants receiving methylphenidate, commonly known as Ritalin.
David Merrill, MD, PhD, a board-certified geriatric psychiatrist, emphasized the need for careful patient selection, dose titration, and close monitoring when prescribing amphetamines, especially for patients with a history of mental health issues or those at high risk for psychosis. He recommended using the lowest effective dose, initiating treatment with extended-release formulations, and using nonpharmacologic interventions as first-line treatments whenever possible. Regular mental health evaluations and more frequent follow-ups were also advised, particularly during the initiation and titration phases of amphetamine therapy.
Stacy Doumas, MD, MBA, chairwoman of Psychiatry at Hackensack Meridian Jersey Shore University Medical Center, expressed concern about the study’s findings but noted that they were not surprising given the activity of amphetamines on neurotransmitters in the brain. She highlighted the importance of looking at the evidence base for prescribing medication to avoid harm, especially with the potential risk of psychosis associated with high doses of amphetamines. Future research should focus on exploring the causal relationship between high-dose amphetamine prescriptions and the risk of psychosis and mania through longitudinal cohort studies, pharmacovigilance studies, and mechanistic studies.
In conclusion, the study conducted by researchers at McLean Hospital found that high doses of prescription amphetamines are associated with an increased risk of developing psychosis or mania. The findings emphasize the importance of careful patient selection, dose titration, and monitoring when prescribing amphetamines, particularly for individuals with a history of mental health issues or those at high risk for psychosis. Future research should further investigate the causal relationship between high-dose amphetamine use and the risk of psychosis and mania through longitudinal cohort studies, pharmacovigilance studies, and mechanistic studies to better inform the potential risks associated with the use of amphetamines.
