Adderall Induced Psychosis: Symptoms and Risk Factors for Using Adderall

Adderall can help many people with attention deficit hyperactivity disorder to function better when it is used exactly as prescribed. Like all stimulant medications, however, it also has risks. One of those feared possible risks is Adderall-induced psychosis, especially in cases where someone experiences paranoia or hallucinations.

This situation can be very scary both for the person experiencing it and for family members who may see it happening. Therefore, understanding what stimulant-induced psychosis looks like, which factors increase risk for this condition, and how to seek emergency care if needed will allow you to respond quickly and safely to any new-onset symptoms of psychosis.

What Is Adderall Induced Psychosis?

Adderall induced psychosis involves developing psychotic symptoms during or after taking Adderall. Psychosis involves difficulty separating reality from fantasy. Symptoms may involve hallucinations, delusions, paranoia, disordered thinking, agitation, or abnormal behavior.

Adderall is a central nervous system stimulant composed of mixed amphetamine salts (amphetamine and dextroamphetamine). It is United States Food and Drug Administration (FDA) approved for the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy.[1] As it is classified as a Schedule II controlled substance, it has a high potential for abuse, misuse, and addiction.

The mechanisms behind how Adderall stimulates the brain to produce these psychotic symptoms is believed to be due to excess levels of dopamine and norepinephrine in the brain. These neurotransmitters play key roles in regulating attention, alertness, motivation, and reward. Excessive levels of dopamine and norepinephrine caused by high doses or misuse of Adderall may lead to psychotic symptoms.

It is essential to remember that Adderall induced psychosis does not necessarily equate to a person having schizophrenia or another type of primary psychotic disorder. Substances can induce psychosis that appears very similar; however, the causation, timing, and treatment options may vary depending upon the circumstances. Therefore, a competent medical professional should assess any new onset of psychotic symptoms.

Can Adderall Cause Paranoia?

Yes. Adderall can cause paranoia in some people.

According to the FDA-approved labeling for Adderall, central nervous system stimulants, even at recommended doses, may cause psychotic or manic symptoms such as hallucinations, delusional thinking, or mania in people without a prior history of psychotic illness or mania [2].

Paranoia can manifest itself in various forms. For example, a person may feel as though other people are watching, carefully observing them, thinking negatively about them, tracking their movements, reading their mind, and/or plotting against them. Furthermore, a person may begin questioning their own sanity, safety, or trustworthiness based on their perception that others are acting suspiciously towards them.

As noted above, Adderall induced paranoia and hallucinations can be increased in individuals who take more than prescribed amounts of Adderall, obtain prescriptions illicitly, combine Adderall with other drugs or substances, or remain awake for extended periods of time. However, since psychosis can occur at therapeutic doses, anyone who develops new paranoia should immediately report it to his or her doctor.

Signs and Symptoms of Psychosis From Adderall

Psychotic symptoms resulting from the use of Adderall may range from mild anxiety or irritability to severe stimulant-induced psychosis. The development of psychosis symptoms can either progress slowly or rapidly.

Possible manifestations include:

• Intense suspiciousness or paranoia
• Hearing voices or sounds that other people cannot hear
• Seeing things that are not there
• Fixed false beliefs or delusions
• Feeling watched, followed, or threatened
• Disorganized thinking or disorganized speech
• Extreme restlessness or agitated state
• Panic or fear
• Confusion
• Insomnia or lack of sleep for several days
• Mania or racing thoughts
• Aggressive behavior
• Unpredictable behavior
• Loss of insight into reality

Some possible physical symptoms that result from stimulant misuse or overdose may include elevated blood pressure, chest pain, tachycardia, overheating, tremors, anxiety, or a panicked state. Physical symptoms necessitate medical treatment, especially if they accompany psychosis symptoms.

What Causes Amphetamine-Induced Psychosis?

Amphetamine-Induced Psychosis generally results from the manner in which stimulants alter the levels of dopamine and norepinephrine in the brain. By increasing the activity of these two neurotransmitters in the brain, Adderall improves attention, wakefulness, motivation, and reward. However, when excessive dosages are administered, or the individual is susceptible to developing psychosis, dopamine activity may contribute to psychotic symptoms.

There are several contributing factors that may increase the likelihood of developing Amphetamine-Induced Psychosis:

• Taking higher doses than prescribed
• Taking more frequent doses than prescribed
• Using prescription amphetamines without a prescription
• Crushing, smoking, or injecting stimulant medication
• Combining Adderall with alcohol, cannabis, cocaine, opioids, or other substances
• Prolonged lack of sleep (sleep deprivation)
• High stress levels
• Pre-existing history of psychosis, bipolar disorder, mania, or schizophrenia
• Family history of psychotic disorders or bipolar disorder
• Co-occurring substance use disorder
• Stopping and restarting stimulant medications without medical guidance

Studies conducted among adolescents and young adult populations with ADHD revealed that approximately 1 in 660 participants developed new-onset psychosis as a result of being treated with stimulants; furthermore, amphetamine usage was associated with an increased risk compared to methylphenidate [3]. As stated before, this does not mean that most individuals will develop psychosis when taking Adderall; rather, it suggests that the risk exists and should be given serious consideration.

How Long Does Adderall Psychosis Last?

The length of time that Adderall psychosis persists is directly dependent upon the dosage amount, administration duration, deprivation of sleep, use of additional substances, and history of pre-existing mental health disorders.

Symptoms may improve after the stimulant has been eliminated from the body and someone receives adequate rest, hydration, and emergency medical services. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), hallucinations usually cease within 24 to 48 hours post cessation of stimulant use, whereas paranoia and altered perception may diminish over the course of 7 to 15 days [4].

In some instances, the symptoms may last longer than anticipated. Symptoms may persist when someone continues to take stimulants, uses additional substances, experiences repeated episodes of psychosis, or has previously had bipolar disorder or schizophrenia. If symptoms continue or deteriorate after discontinuation of Adderall, emergency services or psychiatric evaluation is strongly advised.

Do not attempt to wait out severe psychosis by yourself if you are unsure about your safety. Emergency services should be contacted immediately if somebody is hallucinating, threatens self-harm, unable to sleep for days, manifests unpredictable behavior, or loses touch with reality.

When Should I Call 911 for Adderall Psychosis?

Contact emergency services (e.g., call 911 or go to the nearest hospital emergency department) if somebody has:

• Hallucinations or delusions that increase risk to self or others
• Suicidal ideations or intentions
• Intentions to harm others
• Extreme agitation or aggression
• Chest pain or seizures
• High fever
• Extensive confusion
• Fainting or has difficulty breathing
• Evidence of elevated blood pressure
• Inability to sleep for extended periods of time
• Suspected overdose or polysubstance use

Emergency service personnel are trained to assist individuals in acute crisis situations. The American Society of Addiction Medicine (ASAM) and American Academy of Addiction Psychiatry (AAAP) stimulant use disorder guideline emphasizes that the presence of high fever, seizure, chest pain, psychosis, or suicidality indicates an urgent need for emergency medical services [5].

If possible, provide emergency responders with information regarding what was taken, how much was taken, when it was taken, and if additional substances were ingested. Do not debate with somebody who is paranoid or hallucinating. Remain calm, lower your voice, reduce stimuli, create distance between the person and yourself, and orient them towards receiving assistance.

How Do I Get Help?

Depending on severity, the prescribing physician may stop, reduce, or change medication and monitor symptoms closely, or alternatively provide inpatient psychiatric care or urgent outpatient emergency services.

Potential treatments include:

• Stopping or reducing stimulant under medical supervision
• Medical monitoring of heart rate, blood pressure, hydration, and temperature
• A low-stimulation environment
• Medically required treatment for agitation
• Antipsychotic treatment for clinically appropriate psychotic symptoms
• Sleep deprivation treatment
• Assessment and diagnosis for bipolar disorder, schizophrenia, or other mental health issues
• Substance use disorder evaluation
• Detoxification or addiction treatment if misuse of Adderall is present
• Follow-up psychiatric support after improvement of symptoms

Cognitive behavioral therapy (CBT) can also assist during recovery following misuse of a stimulant, substance use disorder, or co-occurring mental illness. CBT is talk therapy focused on identifying and changing maladaptive behaviors. CBT is not an emergency solution for active psychosis; however, it can be beneficial once stabilization has been achieved as part of longer-term support.

Not everyone who experiences side effects from Adderall has developed a stimulant use disorder. However, taking more than prescribed, using Adderall for reasons other than directed, needing increasing amounts, experiencing cravings or withdrawal symptoms, or continuing to use despite physical or mental health consequences may indicate that additional support is needed.

If Adderall or another prescription stimulant has become difficult to control or is beginning to affect your physical health, mental health, relationships, work, or daily life, you can speak with our admissions team to determine whether medically supervised detox, inpatient residential treatment, dual diagnosis care, or another form of support may be appropriate.