Adderall is a popular stimulant treatment for ADHD and is used illicitly as a drug for its energy inducing effects.
What are the long term effects of Adderall? Does it keep working, or do you develop tolerance if you have ADHD?
Please note that this piece is written assuming use is within therapeutic range for ADHD and not at the high doses typical with abuse.
Have you ever wondered what the difference really is between Adderall and Ritalin? Find out here.
Also, an ADHD Test Made for Adults may be of interest.
Summary of long term effects of Adderall
Mental: Increased focus, attention, motivation. Reduction of ADHD symptoms.
Heart: Use of Adderall or related stimulants for more than a year increases your diastolic blood pressure by ~ 3-5mm HG, systolic blood pressure by ~ 2-5mm HG and your heart rate ~ 3-5 beats per minute. Additionally, it is possible that ECG testing will show slight electrical activity differences.
This is almost always not good (except possible in someone with initial low blood pressure), but is it bad? Some argue that these increases don’t have any direct health implications, while others argue that they can show a 20% increase in emergency room use for heart issues in kids who use stimulants.
Before using stimulants, it may make sense to get some basic cardiac testing.
Brain: Some studies have shown that stimulant use in people with ADHD may increase the size of certain parts related to controlling focus, motivation and attention. This is very positive. Some studies we’ve looked at of students on long term use of stimulants showed improvement in overall academic performance as well.
On the other hand, some animal models have hinted at the possibility that use of stimulants can increase the build up of free radicals in the brain. Even if this is the case, it might be amenable by healthy consumption of anti-oxidants.
Appetite/weight: Amphetamines like Adderall are among the best appetite suppressers. This led to their wide abuse as diet pills and may cause unwanted weight reduction in people who use them. Long term use in kids has been shown to be associated with slight weight loss and even possibly slight height reduction.
ADHD Treatment Effect: Many people taking stimulants ask the question – will they stop working? The news seems to be good, however.
Researcher Doctor Biederman reports that in a study of several hundred patients over 1-2 years, for most, stimulant medications continued to work well at a steady dose.
Doctor Hallowell, coauther of Driven to Distraction, reports that in almost all cases, tolerance to ADHD medication does not develop, but is possible. Dr. Paul Wender, a noted researcher into ADHD, reports that tolerance is rare, and most patients can take stimulants for many years without problem.
Dr. Ari Tuckman, a clinician who has treated hundreds if not thousands of people with ADHD, reports in an interview with us that most often, ADHD meds can be used at therapeutic dose daily for years without losing efficacy.
Of the dozens of research papers reviewed, very few mentioned that developing long term tolerance was a limiting factor in treating ADHD. Even then, it is almost always the case that tolerance can be reduced or removed by temporarily stopping treatment.
That said, there could be more research and data on this subject.
What does that mean?
With the increasing use of amphetamines to treat ADHD and as recreational drugs, more and more people want to know – are they safe for long term use? What potential side effects come with use over time? And, this is exceptionally important, do they continue to treat ADHD over time or does drug tolerance develop?
There have not been that many studies into the long term effects of Adderall. One thing we know is that stimulants do have some cardiovascular effects which can be serious for at risk people. That said, one study of several hundred people over 2 years of mixed amphetamine salt treatment (the generic for Adderall), showed no clinically relevant heart effects – at least according to the doctors and researchers who did the trial. A few people did drop out because of heart related concerns like palpitations and excessive heart rate.
Additionally, a retrospective analysis of about 2,000,000 kids treated over time with stimulant medications showed that 456 went to the emergency room with heart related issues. When you control for how many kids would normally go to the ER in a sample that large, this represents a 20% increase in risk for heart problems.
Remember, there is a black box warning on stimulants because of their potential for heart complications.
In terms of developing tolerance to the therapeutic effect in treating ADD/ADHD: the data seems to very strongly suggest that tolerance does not develop over a year or two year period, and that use of extended release formulations may increase efficacy due to smoother release.
Attenuation of side effects?
It is possible that with time, the side effects of stimulants become attenuated, or less significant. For instance, one study showed that a significant amount of people experienced insomnia, depression or weight loss at start of use of stimulant medication.
But near the end of a year, only 1% still had a reduction in appetite that would lead to weight loss, and no one reported insomnia (which sounds a little over-optimistic. Everyone has insomnia sometimes.) This may be, however, because those who had serious difficulty with those issues stopped using the medication.