Stimulants for ADHD and risk of psychosis has been a clinical concern but the risk has thought to be quite low. Dr. Goodman’s comments about the study can be read here. The recent New England Journal of Medicine study has demonstrated the risk of psychosis with amphetamines is 0.2% and methylphenidate is 0.1%. These findings were generated from two very large health insurance databases. The study analysis are statistically sound and the authors duely note limitations to be considered when interpreting the data. While the risk of psychosis is a clinical concern and should be identified quickly when it occurs, it is a rare phenomenon. The Number Needed to Harm is 1 in 660. That means that this event may occur once in 660 patients.

For patients, families, and prescribers, effective medications for ADHD should not be avoided because of these findings. While the risk of psychosis from stimulants is rare, the negative consequences of ADHD are numerous: more likely to not finish high school, more likely to drop out of college, more likely to take longer to finish college degree, more likely to be involve in criminal behavior and get arrested, more likely to abuse drugs and alcohol, more likely to have concussions, more likely to have multiple jobs over 10 years, more likely to be in motor vehicle accidents/injuries, more likely to get divorced, more likely to declare personal bankrupcy, more likely to be fired from a job….get the idea! Untreated ADHD impact on life is far greater than the rare risk of psychosis occurring.

If you or a loved one starts acting peculiar or saying things that sound bizarre while on ADHD medication, this is the time to consider psychosis. Contact the treating prescriber and alert them. The person should get evaluated as quickly as possible.

David W. Goodman, M.D., FAPA