Adderall refers to the active psychostimulants of the phenethylamine group. It is widely used for the treatment of narcolepsy, ADHD, and hyperactivity. This drug is well tolerated and effective, but in some cases, the use of Adderall is contraindicated:
- You should not take Adderall if you have abuse of drugs or alcohol, heart disease, neurotic diseases, atherosclerosis, glaucoma (increased intraocular pressure), hyperthyroidism (excessive production of the thyroid hormone), hypertension.
- Adderall is prescribed with caution and under constant supervision to patients with bipolar disorder, depression, hypertension, liver and kidney disease, psychosis, Raynaud’s syndrome, and convulsions.
- As well, this drug cannot be prescribed if the patient has been used inhibitors for the last 14 days.
- Patients with mental disorders and nervous system diseases should especially carefully take the medicine.
- In the event of a significant overdose of the drug, the patient has a deterioration of cognitive functions and rapid muscle disorder. There is also a high risk of psychotic disorders (paranoid and delusional states).
DEPENDENCE, ADDICTION, AND WITHDRAWAL
While the risk of developing addiction as a result of recreational use and abuse of Adderall is high, the risk in a typical medical use is unlikely. Tolerance develops rapidly in case of abuse of Adderall, so with the prolonged use of the drug, in order to achieve the same effect, it is necessary to increase the amount of the drug. According to a review conducted by the Cochrane Collaboration regarding the withdrawal of the drug in persons strongly dependent on amphetamine and methamphetamine, “with the sudden withdrawal of Adderall in regular users, many have a limited time-abstinence syndrome within 24 hours after taking the last dose.” The review notes that the withdrawal syndrome is often observed in regular users taking high doses of the drug, and occurs in 87.6% of cases, remaining for 3-4 weeks with a “crash” phase during the first week. Symptoms of amphetamine syndrome may include:
- dysphoric mood,
- increased appetite,
- increased drowsiness or insomnia,
- bright or conscious laziness,
- increased or decreased mobility,
- anxiety, and
- the development of drug cravings.
The review states that withdrawal symptoms are related to the degree of addiction, suggesting that therapeutic use is associated with much milder withdrawal symptoms. USFDA does not indicate the presence of withdrawal symptoms after discontinuation of Adderall after a long period of drug use in therapeutic doses.
Abuse of Adderall can lead to the development of a stimulant psychosis, which can be represented by various symptoms such as paranoia, hallucinations, and delusions. The Cochrane Collaboration review on the treatment of psychosis associated with amphetamine, dextroamphetamine and methamphetamine dependence shows that about 5-15% of users are not able to fully recover. As well, this review shows that, based on at least one trial, it has been shown that antipsychotics effectively reduce the symptoms of acute amphetamine psychosis. In the therapeutic use of amphetamine, the development of psychosis is unlikely.
Overdosing with drugs containing amphetamine can lead to death and requires a close medical supervision. In case of moderate overdose, patients become disoriented in time and space, consciousness is confused, and body temperature is increased. They may have hyperreflexia and low blood pressure. Patients complain of myalgia, severe tremor, and tachycardia. In case of severe overdose, oliguria or anuria and kidney/liver failure may occur.
There is no evidence that Adderall or racemic amphetamine, directly or indirectly, can have a neurotoxic effect on humans, even when taken it in high doses. On the other hand, there is evidence of in vitro studies that amphetamine is a neurodegenerative and neuroprotective agent, which is associated with an increase in activity of the psychostimulatory cocaine protein and amphetamine transcript.