High-Dose Amphetamines linked to Increased Psychosis and Mania Risk, reports research

A recent study published in the American Journal of Psychiatry raised concerns about the increasing prescription rates of amphetamines in the United States by revealing a heightened risk of psychosis or mania associated with high doses of these medications. This study employed electronic health records from McLean Hospital to examine the link between amphetamine use and serious psychiatric outcomes, particularly psychosis and mania, in young adults.

This case-control study spanned the years 2005 to 2019 and focused on patients aged 16 to 35 who were hospitalized for incident psychosis or mania. These patients (case subjects) were compared with control subjects, individuals hospitalized for other psychiatric reasons, primarily depression or anxiety.

The study found a significant association between amphetamine use and psychosis or mania, with the risk increasing with higher doses. Among the 1,374 case subjects and 2,748 control subjects, those who had been prescribed amphetamines in the past month were 2.68 times more likely to develop psychosis or mania when compared to the ones with no recent amphetamine use. Also, a dose-response relationship was observed, with the highest amphetamine doses (over 30 mg dextroamphetamine equivalents) associated with a 5.28-fold increase in the odds of psychosis or mania.

This dose-dependent relationship highlighted the potential dangers of high-dose amphetamine prescriptions for young adults who may be more vulnerable to psychiatric side effects. This research emphasized that while amphetamines are effective for treating conditions like attention-deficit hyperactivity disorder (ADHD), clinicians should be cautious when prescribing high doses by ensuring regular screening for symptoms of psychosis or mania.

This study also evaluated the use of methylphenidate, commonly prescribed for ADHD, such as Ritalin and Concerta. Unlike amphetamines, past-month methylphenidate use was not linked to an increased risk of psychosis or mania. The adjusted odds ratio for methylphenidate was 0.91, indicating no significant association.

The study observed potential limitations in their findings, including the use of hospitalized control subjects, which may introduce selection bias, as it excludes individuals with less severe psychiatric symptoms. Overall, the findings illuminate the importance of monitoring for adverse psychiatric outcomes in patients receiving high-dose amphetamines.

Source:

Moran, L. V., Skinner, J. P., Shinn, A. K., Nielsen, K., Rao, V., Taylor, S. T., Cohen, T. R., Erkol, C., Merchant, J., Mujica, C. A., Perlis, R. H., & Ongur, D. (2024). Risk of Incident Psychosis and Mania With Prescription Amphetamines. In American Journal of Psychiatry. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.ajp.20230329