- Addiction & recovery
What is Adderall?
Vanessa de la Cruz, MD
March 7, 2022
Adderall is the brand name for a prescription medication that contains a combination of amphetamine and dextroamphetamine. Approved by the U.S. Food and Drug Administration (FDA), Adderall is a stimulant prescribed for the treatment of attention-deficit hyperactivity disorder (ADHD) and narcolepsy in both adults and children. Adderall works by changing the amount of certain natural substances in the brain, especially dopamine and norepinephrine. And improves an individual’s concentration, alertness, and focus.
Adderall is generally available in two forms:
- Adderall oral tablet
- Adderall XR extended-release oral capsule
Adderall may also be used off-label for treating depression, bipolar disorder, and weight loss. As a Schedule II controlled substance, Adderall has a high potential for misuse and dependence. Adderall is misused for its capacity to generate intoxicating effects. While some, especially college students, use it in hopes of increasing productivity and athletic performance, however, this practice carries a high risk. According to the National Institute on Drug Abuse (NIDA), prescription stimulant medicines have been increasingly misused among college students for the past several years.
Adderall for ADHD
Attention-deficit hyperactivity disorder is a relatively common neurodevelopmental disorder of childhood that often lasts into adulthood. Symptoms include difficulty in paying attention or controlling impulsive behaviors or hyperactivity. Children with ADHD may have trouble managing everyday life, learning, or even socializing.
Adderall is considered a first line of treatment for ADHD. Studies reveal that stimulant treatment with Adderall increases dopamine production and improves concentration, focus, and impulse control. And between 70-80% of children and 70% of adults with ADHD see an improvement in their symptoms while using stimulants such as Adderall. Adderall is only prescribed for children aged three and older. It is not intended for children who exhibit symptoms secondary to environmental factors or indicate other psychiatric disorders, such as psychosis.
Adderall for Narcolepsy
Narcolepsy is a chronic sleep disorder that affects the brain’s regulation of sleep-wake cycles. Individuals with this condition may find it difficult to stay awake for long periods, regardless of the situation, and feel extremely tired during the daytime. Narcolepsy can cause serious disruptions to everyday life and inhibit academic, social, and work activities.
Stimulant treatment for narcolepsy works by increasing brain levels of dopamine and improving alertness and wakefulness. It also helps regulate sleep-wake cycles by increasing the levels of serotonin and norepinephrine to a lesser degree. However, the effectiveness of long-term Adderall use has not yet been systematically evaluated in controlled trials. Thus, healthcare providers who utilize this medication for extended periods should periodically evaluate the long-term benefits of the medication based on individual patient responses.
How to Take Adderall?
Take Adderall exactly as prescribed by your healthcare professional or directed on the label. And do not use it in larger or smaller doses or longer than recommended. Dextroamphetamine/amphetamine can be habit-forming. Thus, its misuse can result in dependence, overdose, and death. If you require further medical advice, seek counsel from health professionals.
The immediate-release tablet (Adderall) is usually taken 2-3 times daily, 4-6 hours apart, with or without food. In contrast, Adderall XR is usually taken upon awakening, with or without food. The dextroamphetamine and amphetamine combination is taken before late afternoon or evening, as taking it later in the day can cause sleep troubles (insomnia).
The dosage may depend on your medical condition and response to treatment. And may change if you gain or lose weight. Your healthcare provider may start you on a low dose and adjust as needed to determine the best dose for your condition. Your treatment progress will be evaluated at regular intervals, and you may also be required to stop using Adderall from time to time to see if the medication is still required.
Who Should Not Use Adderall?
Although Adderall is an effective treatment option for ADHD and narcolepsy, it may not be suitable for everyone. The combination of dextroamphetamine and amphetamine is not suitable for individuals with:
- An allergic reaction to stimulant medicines
- High blood pressure, heart disease, or coronary artery disease (hardened arteries)
- Overactive thyroid
- Severe anxiety, tension, or agitation
If you have a history of a substance use disorder, the decision as to whether to start a stimulant medication such as Adderall must be considered carefully. It is important to discuss the risks and benefits of stimulant treatment with your healthcare provider.
To ensure that the medication is safe, it is also crucial that you inform your healthcare practitioner of any family history of:
- Depression, bipolar disorder, psychosis, suicidal thoughts or behaviors, or any other mental disorder
- Motor tics (muscle twitches) or Tourette’s syndrome
- Seizures or epilepsy
- Kidney disease
- Blood circulation problems in the hands and feet
- An abnormal brain wave test (EEG)
Adderall is also not recommended for anyone who has taken a monoamine oxidase inhibitor (MAOI) in the past 14 days, as dangerous drug interactions could occur. MAO inhibitors include linezolid, isocarboxazid, methylene blue injection, phenelzine, rasagiline, selegiline, and tranylcypromine. Adderall is also not approved for use in children below three years.
Adderall and Pregnancy
Infants born to mothers dependent on Adderall may be born prematurely, have low birth weight, or experience withdrawal symptoms, such as mood swings, agitation, or unusual tiredness. Thus, this medication during pregnancy should only be used if recommended by your treatment provider. Discuss the risks and benefits with your treatment provider if you are pregnant or plan on getting pregnant. Adderall can also pass into breast milk and cause adverse effects on the nursing baby. Hence, breastfeeding is generally not recommended while using this medication.
Side Effects of Adderall
Adderall can cause side effects ranging from mild to severe. These side effects tend to disappear within a few days or weeks. Some of the common side effects of Adderall include:
- Lack of appetite
- Dry mouth
- Trouble sleeping
- Stomach pain
- Weight loss
Inform your healthcare practitioner immediately if the side effects of Adderall persist or worsen.
Some of the severe side effects of Adderall include:
- Heart defects, including high blood pressure, rapid heartbeat, heart attack, and stroke
- Agitated or aggressive behavior
- Impaired or delusional thinking
- Blurred vision
- Severe allergic reaction (hives, breathing difficulty, or swelling of the face, lips, tongue, or throat)
- Muscle breakdown called rhabdomyolysis
- Shortness of breath
- Chest pain
- Excessive tiredness
- Slow or difficult speech
- Weakness or numbness of an arm or leg
If you experience any of the severe side effects of Adderall, call your healthcare provider immediately or get emergency medical treatment.
Long-Term Effects of Adderall
Prolonged use of Adderall can increase the risk for heart defects, including heart attacks and stroke. Long-term use of Adderall can also cause mood or behavioral changes and affect growth in children.
Other consequences of long-term Adderall use include:
- Skin disorders from picking at the skin during hallucinations
- Seizures or convulsions
- Trouble breathing
- Erectile dysfunction
- Toxic psychosis
Toxic psychosis is a mental illness attributed to substance misuse. Symptoms include confused thinking, delusions, hallucinations, mood swings, and behavioral changes. Toxic psychosis can be resolved with medical attention, including detox and abstinence in most cases.
Adderall Use Disorder
Long-term, regular use of Adderall or other stimulants can cause a few changes in the brain, including reducing the amount of the chemical messenger dopamine. These changes may then prompt individuals to rely on the substance to feel normal, resulting in tolerance and dependence. The risk of dependence remains the same for people who use Adderall for legitimate health conditions. And this is why healthcare professionals closely monitor patients on Adderall for ADHD or narcolepsy treatment.
Individuals with Adderall use disorder may experience various withdrawal symptoms when quitting the substance abruptly, including:
- Sleep problems
- Stomach aches or cramps
Adderall withdrawal symptoms can vary from one person to another but generally appear within one to two days of quitting and last for a few days to several weeks.
Adderall use disorder can be treated using therapeutic techniques to address underlying causes and change maladaptive patterns. These treatment programs may include individual therapy, such as cognitive-behavioral therapy (CBT), among other interventions.
An overdose can occur when someone takes larger doses of Adderall intentionally or unintentionally. An Adderall overdose involves the overstimulation of the sympathetic nervous system, which is responsible for activating the fight-or-flight response in instances of danger. However, as some people are more sensitive to stimulants than others, the dosage that could lead to an overdose may vary from one person to another. And doses of amphetamine as low as 1.5 mg/kg of weight have also been reported to cause negative reactions.
Some of the symptoms of an Adderall overdose include:
- Muscle twitches
- Rapid breathing
- Muscle pain or weakness
- Nausea and vomiting
- Uneven heart rate
An Adderall overdose is a medical emergency that can cause seizures, coma, or death. Thus, individuals are highly advised to seek immediate medical attention if they or a loved one show symptoms of an overdose.
An Adderall overdose is generally treated by administering activated charcoal to help absorb the medication. In the event of serotonin syndrome, you may also be given medication to block serotonin.
Adderall can interact with certain medications and cause various adverse reactions. Some can affect how Adderall works, while others can increase the side effects of the medication. Thus, it is vital to inform your healthcare provider about all prescription, and over-the-counter medications, vitamins, and herbal products you use to avoid potential interactions.
Some of the medications Adderall may interact with include:
- Buspirone, lithium, selective serotonin reuptake inhibitors (SSRI), tricyclic antidepressants, or other medications used to treat depression or mental illness.
- Heartburn medicines
- Blood pressure medicines
- Blood thinners such as warfarin
- Cold or allergy medicines that contain a decongestant
- Opioid medicines
- Seizure medicines
Adderall is an effective medication in treating ADHD and narcolepsy. But at the same time, it also has a potential for misuse and dependence that should not be overlooked.
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