Adderall Psychosis: Identifying Signs & Symptoms

What Is Adderall Psychosis?

Adderall is a prescription medication that contains amphetamine and dextroamphetamine. Adderall is most often used for the treatment of ADHD, but it is also FDA-approved for the management of narcolepsy. Adderall works by increasing norepinephrine and dopamine in the brain. These chemicals are associated with attention and impulsivity, and increased levels in the brain lead to improved attention and impulse control.¹

Although it rarely occurs, taking stimulant medications such as Adderall can cause psychosis.² This is likely due to the increased dopamine in the brain.³ Psychosis is when an individual experiences irregular thoughts and perceptions with difficulty recognizing what is real and what is not real.⁴ Symptoms of psychosis may include delusions, hallucinations, trouble thinking clearly, inappropriate behavior, and incoherent speech.

Can Stimulants Causes Psychosis?

Drug-induced psychosis refers to a condition in which the use of substances causes symptoms resembling those of psychosis. This type of psychosis is distinct from psychosis unrelated to substance use, which is often seen with mental disorders such as schizophrenia. Drug-induced psychosis and psychosis from mental illness are uncommon. Approximately 0.21% of those taking Adderall develop psychosis, and 0.1% or less of individuals develop psychosis from all causes, such as mental health conditions.^{3, 4}

What Are the Signs of Adderall Psychosis?

Psychosis is a rare but serious side effect of taking Adderall. The risk of developing psychosis is increased in those who misuse Adderall, such as by taking more than prescribed or taking Adderall in inappropriate ways (such as snorting or injecting the drug). Psychosis can include a variety of symptoms, including hallucinations, delusions, and paranoia.

Key signs of psychosis include:

• Hallucinations: Experiencing sensations that aren’t real, such as hearing or seeing things others don’t.
• Paranoia: Intense fear or suspicion of others, including feeling like one is being targeted or persecuted.
• Delusions: False or irrational beliefs that persist despite evidence to the contrary.
• Behavior changes: Inappropriate or unusual behaviors for the situation.

Other symptoms of psychosis may include:⁴

• Suspiciousness
• Trouble thinking clearly
• Social withdrawal
• Unusual ideas or feelings
• Diminished self-care
• Disruptions in sleep
• Confused speech
• Sudden problems in work/school

*All medications, including Adderall, have a risk of side effects, including serious side effects. This is not a complete list of side effects. You should talk with your healthcare professional about the benefits and risks of any medication before starting treatment.

What Causes Adderall Psychosis?

Psychosis is rare, but it has been shown to be a possible side effect of Adderall. Psychosis caused by Adderall occurs in approximately 0.21% of individuals taking Adderall.⁴ The underlying cause of Adderall psychosis remains unclear and is likely based on many factors. The way Adderall works, by increasing norepinephrine and dopamine in the brain, likely plays a role in the development of psychosis. The alteration in these chemicals can disrupt the delicate balance in the brain, leading to the symptoms of hallucinations, paranoia, and delusions.

Risk Factors for Adderall Psychosis

Certain individuals may be at an increased risk of developing Adderall psychosis. Those with a history of psychiatric disorders, especially psychosis-related conditions such as schizophrenia or bipolar disorder, are more likely to develop psychosis when taking Adderall.

Other contributing factors that may increase the risk of Adderall psychosis include taking a higher dose, misuse of the medication, and a genetic predisposition or family history of psychiatric conditions. These factors collectively increase the risk of psychosis in individuals using Adderall, emphasizing the importance of cautious prescription and monitoring.

Potential risk factors for developing Adderall psychosis include:⁵

• Sleep deprivation: Sleep deprivation increases the risk of developing psychosis. This is important to be aware of, as Adderall can cause insomnia.
• History of a mental health condition/s: Individuals with mental health disorders are at an increased risk of developing psychosis, especially those with psychosis-related conditions such as schizophrenia or bipolar disorder.
• Dosage: Taking high doses of Adderall increases the risk of psychosis, especially if taking more than prescribed or inappropriately, such as by snorting or injecting the drug.
• Genetics: Some individuals are at an increased risk of Adderall psychosis due to genetics and family history. Several genes known to increase the risk of psychosis have been found.
• Other drug use: There is an increased risk of psychosis in individuals taking Adderall with other drugs, such as opiates, benzodiazepines, cannabis, and alcohol.

How Long Can Adderall Psychosis Last?

The duration of Adderall psychosis can vary widely from person to person depending on factors such as the individual’s overall health, duration of Adderall use, dosage of the medication, and use of other drugs. Most often, the symptoms of psychosis resolve after discontinuation of the medication. There is a risk that psychotic symptoms persist after discontinuation, which may be due to an underlying disorder such as schizophrenia or bipolar disorder.⁶

How to Prevent Adderall Psychosis

Preventing Adderall psychosis primarily involves responsible medication use and close monitoring by healthcare professionals. Adhering to prescribed dosages and usage is critical to lower the risk of developing psychosis. Individuals should avoid altering the dosage without medical advice, and regular communication with the prescribing healthcare provider is essential.

Seeking Professional Help for Adderall Psychosis

It is essential to report any unusual or concerning mental health symptoms to your healthcare provider immediately. A healthcare professional can conduct a comprehensive assessment and review the medication’s usage to determine if the symptoms are related to Adderall use. Timely intervention can prevent the symptoms from worsening, leading to potential long-term problems.

Talk to Your Prescriber About Your Symptoms

Open communication with your healthcare provider regarding any concerning symptoms or history of mental health disorders is necessary to lower the risk of developing psychosis. Individuals should be aware of the key symptoms of Adderall psychosis and discuss with their healthcare providers if they are beginning to experience them. Additionally, sharing any past or present mental health conditions with help the prescriber determine the risk of developing psychosis.

Take Medication As Prescribed

Strictly adhering to the prescribed dosage and usage guidelines is essential for the safe and effective use of Adderall. Taking the medication as prescribed helps maintain a consistent level of the drug in the body, optimizing the drug’s benefit and minimizing the risk of side effects, including psychosis.

Tell Your Prescriber About Any Mood or Behavioral Changes

Continuous monitoring for mood or behavior changes while on Adderall is imperative. Immediately Notify your prescriber if you are experiencing any of these changes. This may include increased anxiety, agitation, or unusual thought patterns. Keeping a close eye on these changes allows for immediate intervention and adjustment of the treatment plan.

Adderall Alternatives

If you have a history of psychosis or are at an increased risk for developing psychosis, it may be best to avoid Adderall and use an alternative medication. The risk of developing psychosis with other stimulant medications, such as methylphenidate, is lower when compared to Adderall.³ However, it may be recommended to avoid all stimulant medications to further lower the risk of developing psychosis.

Adderall alternatives include:

• Strattera (atomoxetine): Strattera is a selective norepinephrine reuptake inhibitor and non-stimulant medication.
• Tenex/Intuniv (guanfacine): Tenex/Intuniv is a non-stimulant medication that affects cells in the brain similarly to norepinephrine.
• Kapvay (clonidine): Clonidine is a non-stimulant medication that also operates by affecting cells in the brain similarly to norepinephrine.
• Wellbutrin (bupropion): Wellbutrin is a dopamine reuptake inhibitor and releaser that can be used off-label for the treatment of ADHD.

Questions to Ask Your Healthcare Provider About Adderall Psychosis

Before taking Adderall, it is important to have a thorough understanding of Adderall and its side effects, including the risk of psychosis. You should ask your healthcare provider how to identify the symptoms of psychosis and what to do if these symptoms develop. You should also discuss your health history with your healthcare provider to determine if you are at a higher risk for developing psychosis.

Questions to ask your care team about Adderall psychosis:

• Does Adderall put me (or my child) at a higher risk for psychosis?
• What symptoms of psychosis should I watch for?
• Are there other drugs that might work that don’t cause psychosis?
• How common is Adderall psychosis in patients of my age group or with my medical history?
• What should I do if I experience symptoms of psychosis?
• How quickly can symptoms of psychosis subside after discontinuing Adderall?
• Am I taking other medications that may increase the risk of developing psychosis?
• Are there any warning signs that may indicate a need to adjust my Adderall dosage to prevent psychosis?
• How often should I schedule follow-up appointments to monitor for side effects?