This Month in Psychopharmacology

Risk of New-Onset Psychosis in ADHD is Higher with Amphetamine Than Methylphenidate

Prescriptions for stimulants such as methylphenidate and amphetamine for the treatment of attention deficit hyperactivity disorder (ADHD) have been on the rise. The Food and Drug Administration (FDA) mandated changes to drug labels for stimulants in 2007, on the basis of findings of new-onset psychosis. Whether the risk of psychosis in adolescents and young adults being treated for ADHD differs among various stimulants has not been examined. In a recent study, data was collected from two insurance claims data bases for patients between 13-25 years old who were prescribed methylphenidate or amphetamine between January 2004 and September 2015. The primary outcome was a novel diagnosis of psychosis resulting in administration of an antipsychotic within 60 days of the onset of psychosis. The study included 221,846 patients (110,923 patients taking methylphenidate were matched with 110,923 patients taking amphetamines). There was a total of 343 episodes of psychosis, with 106 episodes (0.10%) in the methylphenidate group and 237 episodes (0.21%) in the amphetamine group (hazard ratio with amphetamine use, 1.65; 95% confidence interval, 1.31 to 2.09). The results suggest that among adolescents and young adults prescribed stimulants, new-onset psychosis occurs in 1 in 660 patients. Amphetamine use was associated with a greater risk of psychosis than methylphenidate.


Reference:

Moran et al. NEJM 2019;380:1128-1138. Abstract


For more information:


This Month in Psychopharmacology: ADHD
Update in ADHD: Focus on Medication Treatments
CME credits: 1.25
Methylphenidate vs. Amphetamine
CME credit: 0.50