ADHD is most often treated by stimulants like Ritalin, Adderall, and Dexedrine. I’m sure you’ve heard of these medications – but what are they? What do they do?
And most importantly – are they safe?
Are Stimulants Safe?
Stimulants are powerful medications, potentially addictive, and can have very serious side effects.
They’re commonly used because they’re effective. Up to 70% of people experience significant symptom relief on them. And the majority of the millions of people who use them are fine. But they do have common side effects, and can rarely cause some quite nasty things.
The most common issues with stimulant use include increased anxiety, nausea or loss of appetite, and insomnia.
The rarer and very serious side effects? To quote an ad for Vyvanse, an ADHD medication, “new psychosis, mania, aggression, growth suppression and visual disturbances” are possible.
Stimulant use might cause heart damage over time. Stimulants typically increase heart rate by ~3-5 beats per minute and also raise blood pressure. One study of more than 50,000 children using stimulants showed an 20% increase in risk of emergency treatment for heart problems.
Use of stimulants by someone with a preexisting heart condition is a big no-no, as they may increase risk of cardiac failure or sudden death.
As mentioned, a rare but serious side effect is that stimulants can cause psychosis, or a break with reality such as paranoia, delusional thinking and hallucinations. Most psychosis occurs in people who were already at risk – but stimulants can cause psychosis in normal people at normal doses.
Stimulants can also cause serious problems with regulating or controlling mood. They can trigger mania in bipolar patients, and cause extreme mood variation even in people not normally at risk for bipolar.
Stimulants change the brain
Do stimulants cause brain damage? Maybe.
Studies in rats have shown that extremely high doses of amphetamines given over a short period of time cause serious damage to the production of dopamine and its transport in the brain. This happens by causing build up of radicals and reactive oxygen species. Methylphenidate, or Ritalin, does not cause this damage, possibly because it only blocks the receptors for reception of dopamine.
But what about normal use?
The rats did not experience neural changes or damage from doses in the normal range. The news isn’t all good, though. Baboons and monkeys, however, did experience brain damage at normal doses, showing a significant reduction in natural production and handling of dopamine.
It’s not clear what this means. Children who take ADHD medication, after all, have larger white brain matter than unmedicated children, indicating a neuro-positive effect.
Remember: use of stimulants in children requires extreme caution and psychological analysis because they are young, more susceptible to side effects, and still developing.
Do stimulants like Adderall and Ritalin stunt growth?
This question is extremely contentious. A number of studies have shown that stimulant use is associated with slightly reduced growth, and, on the other hand, a number have shown that they aren’t.
The evidence, in my opinion, seems to be in favor of a slight reduction in height associated with long term use.
Both sides agree that stimulant use initially slows growth somewhat; the question is if that delay is made up for in the long run.
Stimulant use is, however, associated with some degree of weight loss in the long run.
Stimulants are extremely commonly used for a reason. They work. That said, they are potent substances, and often require supportive psychological therapy on the side to achieve best results.
For someone with a history of anxiety or other psychological problems, or someone with cardiac issues, use of stimulants should be exceptionally cautious if at all. Use in children should also be done with extreme caution and only after appropriate psychological evaluation.
You might like:
Potential Adverse Effects of Amphetamine Treatment on Brain and Behavior: A Review
Comparative Efficacy of Adderall and Methylphenidate in Attention-deficit/Hyperactivity Disorder: A Meta-Analysis
Cardiac Safety of Methylphenidate Versus Amphetamine Salts in the Treatment of ADHD