Current guidelines recommend either methylphenidate or amphetamine as first line treatment of ADHD when a medication is required. Teens and young adults were four times more likely to receive a prescription for amphetamine such as Adderall in 2015 compared to 2004, and 1.6 times more likely to receive one for methylphenidates such as Ritalin, according to the new research.
“There are subtle differences in the way Adderall and Ritalin affect dopamine systems in the brain,” Moran said. Both stimulants work through dopamine pathways in the brain, but Adderall is more likely to cause a release of dopamine, whereas Ritalin is more likely to block the re-uptake, allowing it to linger. The surge of dopamine during a psychotic episode most closely mimics that seen after stimulant use like Adderall, which may explain some of the findings, Moran added.
Dr. Rebecca Baum, a developmental and behavioral pediatrician at Nationwide Children’s Hospital in Ohio who was not involved in the study, says she worries the results may alarm parents and scare them away from effective treatments for their children.
“Any time we use a medication we are certainly thinking about what is the benefit of the medication versus the risk,” said Baum, stressing that ADHD can be a debilitating condition when symptoms aren’t well-controlled, and while psychosis is a real and potentially serious side effect, it is still very rare.
“The vast majority of my patients have ADHD and I have the benefit of being able to treat many patients quite successfully,” said Baum. “Thankfully in my practice it is not a side effect that we see very often,” she added.
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Moran also adds that she and her team focused the study on teens and young adults who were taking stimulants for the first time, emphasizing that for those who have been on these medications and have been taking them as prescribed, the risk is likely even lower.
As for parents and young adults weighing whether to start a medication, Moran hopes the research will prompt a conversation about risks, benefits and alternatives such as behavioral therapy and non-stimulants.