A large, new study found that the stimulant methylphenidate, such as the drugs Ritalin and Concerta, may lower the risk of psychosis when prescribed to younger children with ADHD. <\/p>\n
Children with attention-deficit\/hyperactivity disorder have been identified to be at greater risk of developing psychotic conditions such as bipolar or schizophrenia, compared with neurotypical kids. Some studies have suggested a link to stimulants prescribed for ADHD<\/a>. <\/p>\n The findings, published Wednesday in JAMA Psychiatry, found no difference in psychosis risk between children who were treated with methylphenidate \u2014 considered the most commonly prescribed medication for ADHD \u2014 and those who were not. In fact, sustained methylphenidate treatment, when prescribed to children under age 13, for three to four years appeared to lower the risk.<\/p>\n Approximately 3.5 million children between the ages of 3 and 17 in the United States are prescribed ADHD medications<\/a>. <\/p>\n Researchers from the University of Edinburgh and the University College Dublin analyzed the health records of nearly 4,000 children and adolescents in Finland diagnosed with ADHD. <\/p>\n \u201cWe found overall that although we know that this group is at an increased risk of psychosis, it wasn\u2019t to do with the medication,\u201d said Dr. Ian Kelleher, chair of child and adolescent psychiatry at the University of Edinburgh and the senior author of the study. \u201cThat risk would seem to be due to other factors.\u201d<\/p>\n Kelleher suggested that the link between ADHD and psychosis may be due to the shared genetic risk factors between the disorders and could be completely independent of medication. <\/p>\n Dr. Christian Kohler, professor of psychiatry at the hospital of the University of Pennsylvania, described the results as \u201cthought-provoking and not expected.\u201d<\/p>\n However, he said that this doesn\u2019t completely rule out a possible association in older age groups, particularly people in later adolescence or early adulthood who have been newly diagnosed with ADHD.<\/p>\n Kohler said that one of the concerns with stimulants is that they increase the availability of a key brain chemical called dopamine in a part of the brain linked to emotional regulation known as the limbic system. This may propel some vulnerable individuals to develop erratic thinking and hallucinations <\/p>\n As a result, Kohler suspects there might still be a tipping point, perhaps starting in the late teens, where the risk of psychosis does go up following stimulant treatment.<\/p>\n \u201cWhat if you\u2019re diagnosed with ADHD at 16 and 17 and you\u2019re being put on a stimulant?\u201d Kohler said. \u201cAs clinicians we see, not infrequently, people experiencing some cognitive dysfunction later in adolescence, being diagnosed with ADHD, put on a stimulant and then they experience psychosis within a couple of months.\u201d<\/p>\n Kohler, who was not associated with the new research, said that he was also keen to see a similar analysis conducted with amphetamines. <\/p>\n These are a different class of stimulants typically used in other ADHD medications such as Adderall, which are more commonly prescribed<\/a> to adults with ADHD and privately insured patients. Research has shown<\/a> that patients prescribed amphetamines are more likely to develop psychosis than those who receive methylphenidates.<\/p>\n Dr. Jeffrey Newcorn, director of the division of ADHD and learning disorders at the Icahn School of Medicine at Mount Sinai, said that psychosis risk is thought to be higher in patients prescribed amphetamines. <\/p>\n \u201cThis study doesn\u2019t say you can\u2019t have amphetamine psychosis,\u201d he said. \u201cIt\u2019s very rare with the doses we give, if people take them properly, but it very, very occasionally happens.\u201d Newcorn was not involved in the new study.<\/p>\n