David Cox is a freelance journalist focusing on all aspects of health, from fitness and nutrition to infectious diseases and future medicines. Prior to becoming a full-time journalist, he was a neuroscientist attempting to understand how and why the brain goes wrong.
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. 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. The findings, published Wednesday in JAMA Psychiatry, found no difference in psychosis risk between children who were treated with methylphenidate — considered the most commonly prescribed medication for ADHD — 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. Approximately 3.5 million children between the ages of 3 and 17 in the United States are prescribed ADHD medications. 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. “We found overall that although we know that this group is at an increased risk of psychosis, it wasn’t to do with the medication,” said Dr. Ian Kelleher, chair of child and adolescent psychiatry at the University of Edinburgh and the senior author of the study. “That risk would seem to be due to other factors.” 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. Dr. Christian Kohler, professor of psychiatry at the hospital of the University of Pennsylvania, described the results as “thought-provoking and not expected.” However, he said that this doesn’t 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. 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 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. “What if you’re diagnosed with ADHD at 16 and 17 and you’re being put on a stimulant?” Kohler said. “As 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.” Kohler, who was not associated with the new research, said that he was also keen to see a similar analysis conducted with amphetamines. These are a different class of stimulants typically used in other ADHD medications such as Adderall, which are more commonly prescribed to adults with ADHD and privately insured patients. Research has shown that patients prescribed amphetamines are more likely to develop psychosis than those who receive methylphenidates. 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. “This study doesn’t say you can’t have amphetamine psychosis,” he said. “It’s very rare with the doses we give, if people take them properly, but it very, very occasionally happens.” Newcorn was not involved in the new study. A 2024 study found that people who take high doses of amphetamines, including Vyvanse and generic versions, for ADHD had more than five times greater risk of developing psychosis or mania. Because amphetamines are less commonly prescribed in Europe, there were too few children in the dataset to draw accurate conclusions about drugs such as Adderall and psychotic disorders, Kelleher said. However, he agreed it was worth investigating, as scientists do not know whether people treated with amphetamines are more likely to get psychosis due to the drugs or because they have more severe ADHD. “It’s still a bit of an open question,” he said. “It could be the case that more severe and difficult-to-treat ADHD has more of an overlap, in terms of genetic risk, with psychotic disorders.” Overall, Kohler said he suspects that medication dose, timing of treatment and the stability of the patient’s condition may combine to play a critical role in whether stimulants are protective or liable to cause further problems. Kohler said he was intrigued by the new study’s finding that methylphenidate can play a preventive role in younger children. This finding matches with prior research, carried out in lab mice and rats, which has found that long-term methylphenidate treatment in juvenile animals normalizes some abnormalities in dopamine-rich brain regions. “I think that was really interesting,” Kohler said. “Does it maybe balance or repair an early deficit , so that it doesn’t become a risk for developing psychosis later on.” While there are still many questions to be answered, the researchers said that this new research should hopefully provide some relief for parents of children with ADHD. “It’s reassuring that the risk of a serious lifelong psychotic disorder is not increased by medication,” Newcorn said.
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