Drugs

Adderall: Benefits and Dangers

Introduction

Adderall, otherwise known as dextroamphetamine-amphetamine, is a commonly prescribed drug used to increase focus. It belongs to a class of compounds called amphetamines, which act on the nervous system to increase levels of dopaminenorepinephrine, and serotonin [RR].

Over 3 million children are prescribed Adderall or other stimulants to treat mental disorders such as ADHD. Symptoms of ADHD and other mental disorders include loss of focus, impulsiveness, and trouble staying still [RR].

Adults are also prescribed Adderall. The number of American adults who take Adderall for ADHD jumped 90% from 2002 to 2005 [R].

Adderall is common because it works efficiently and is well-tolerated [R].

However, there are downfalls with stimulants like Adderall because they are often abused. In fact, stimulants are the second most abused drugs by college students.

Many use Adderall to improve school and work performance. This abuse often occurs because students assume that Adderall is “physically harmless” [RR].

Student-athletes may abuse Adderall to improve their exercise performance and increase energy [R].

Adderall use in college students was estimated to be around 2 to 8% per month and 3 to 16% per year [R].

Adderall is a Schedule II drug, meaning that it has a high potential for abuse and dependency. When not being used for performance improvements, it is illicitly used to induce a euphoric high [R].

Disclaimer: We are in no way, shape, or form encouraging or condoning the use of non-prescribed Adderall use.

Components

The components of Adderall include equal proportions of [R]:

  • Dextroamphetamine (d-amphetamine) saccharate
  • D-amphetamine sulfate
  • Levoamphetamine (l-amphetamine) sulfate
  • L-amphetamine aspartate

D- and l-amphetamine are the same molecule, but they are mirror images of the same structure. It is important that Adderall contain both l-amphetamine and d-amphetamine components as they have different properties and may complement each other in treating disorders like ADHD [RR].

A study (DB-RCT) of 11 children found that l-amphetamine works better in some children and d-amphetamine works better in others. Therefore, having both components is useful because it caters to both types of patients [R].

Mechanism of Action

Adderall is a central nervous system stimulant. It causes the release of norepinephrine by stimulating α- and β-adrenergic receptor sites. Adrenergic receptors are those that specifically release neurotransmitters noradrenalineor adrenaline [R].

Stimulating the α-adrenergic receptor sites causes [R]:

  • Constriction of blood vessels all over the body

Stimulating the β-adrenergic receptor sites increases [R]:

  • Heart rate
  • Muscle blood flow
  • Output of blood from the heart

All of these effects help to stimulate the brain into a more active state [R].

Adderall also releases adrenaline in the body, which results in increased energy levels [R].

Adderall prevents neurotransmitters from being taken up, broken down, and stored inside neurons. This is achieved by blocking transporters that bring molecules from the outside of the cell to the inside of the cell. Specifically, Adderall blocks [R]:

  • The dopamine reuptake transporter: It increases dopamine concentrations outside of the cell
  • The noradrenaline reuptake transporter: It increases noradrenaline concentrations outside of the cell

This results in increased activity at the next cell, which is why it is referred to as a stimulant.

Amphetamines also prevent the storage of dopamine in compartments within the cell (vesicles). This increases the availability of dopamine for later use.

Adderall also inhibits the activity of proteins that break down dopamine (monoamine oxidase A and B), which further increases the amount of dopamine available for use in the brain [R].

Individual variations in dopamine levels may be responsible for improving “perceived intelligence” on Adderall. Patients with naturally high dopamine activity may be less likely to experience improvements in intelligence as opposed to patients with relatively average or low levels of dopamine [R].

In adults, amphetamines take longer to eliminate from the body, which increases its abuse potential [R].

Uses of Adderall

1) Adderall Improves ADHD and ADD

Adderall is one of the most commonly prescribed stimulants for ADHD. A study (DB-RCT) of 154 children found that Adderall was effective in 89% of children [RR].

The drug is used mainly in ADHD patients to increase attention and concentration and decrease overactivity and distractedness [R].

In a study (DB-RCT) of 25 children with ADHD, Adderall improved [R]:

  • Rates of negative behavior
  • Academic productivity
  • Staff/parent ratings of behavior

Adderall improved math test scores in a study (DB-RCT) of 30 students with ADHD [R].

There are many studies that support Adderall’s beneficial effects for ADHD. Teacher, clinician, and parent ratings for Adderall are always significantly better than placebo [RRRRR].

Adderall is also widely prescribed for adults and adolescents for short-term management in ADHD. It is estimated to work in 70% of adult/adolescent patients. Long-term Adderall use for ADHD in adults/adolescents has not been proven to be helpful [RR].

2) Adderall Increases Focus

Most people that use Adderall medically use it to increase focus due to conditions such as ADHD or ADD (Attention deficit disorder). Some of the younger generations use Adderall to fight the loss of focus caused by sleep-deprivation [R].

One of Adderall’s main uses is to increase a type of focus called “sustained attention” or vigilance, which is the ability to stay attentive on a task for prolonged periods of time [R].

3) Adderall Increases Energy Levels

In a study of 40 students, increase in energy was the second most improved cognitive function right after attention [R].

In a study (DB-RCT) of 12 adults, d-amphetamine was better than placebo at increasing energy levels [R].

However, in rats, d-amphetamine decreased the production of the following energy molecules in the brain [R]:

  • Glycogen
  • Adenosine triphosphate (only at temperatures > 80.6℉)
  • Guanosine triphosphate (only at temperatures > 80.6℉)
  • Phosphocreatine (only at temperatures > 80.6℉)

These effects were only seen with ambient temperatures greater than 80.6℉ [R].

These studies focus on d-amphetamine, which only makes up a portion of Adderall. Future tests with Adderall need to be implemented for a more accurate representation of Adderall’s effects in increasing energy.

4) Adderall Is Used to Treat Narcolepsy

Narcolepsy is a disorder that causes extreme daytime drowsiness. Adderall is a commonly used stimulant to combat narcolepsy, especially when needed for long periods of time. A form of Adderall, Adderall XR, is preferred as it works for longer periods of time and has a lower potential for abuse [R].

A study on one 60-year-old man with narcolepsy showed that Adderall XR was more effective than alternative medications modafinil and methylphenidate [R].

For late-stage narcolepsy (around 60 years of age), the first line treatments may not be effective and Adderall may be the best medication [R].

5) Adderall May Cause Weight Loss

Before Adderall was used for ADHD, it was prescribed to help reduce weight. Adderall causes weight loss by decreasing appetite [R].

In a study (DB-RCT) of 56 children and adolescents, the most common side effect of Adderall was weight loss. This was more prominent at higher doses.

Weight loss may also be due to the fact that Adderall helps control impulsivity, which prevents users from impulsively snacking or eating [R].

Although Adderall-induced weight loss is usually not severe, it may lead to anorexia. A study (DB-RCT) of 584 children found that anorexia occurred in 21.9% of the children. Similarly, a study (DB-RCT) of 287 teens found anorexia to occur in 35.6% of patients [RRR].

In some rare cases, Adderall may actually cause weight gain. A case study of an 11-year old boy saw Adderall use increase the boy’s weight by 8.8 lbs. in 6 weeks. Changing the timing of Adderall consumption from right after meals to 45 minutes before meals helped to normalize weight gain [R].

6) Adderall Increases Impulse Control

Adderall helps to improve impulse control by decreasing hyperactivity [RR].

One of the main subtypes of ADHD is ADHD with combined inattentive/hyperactive-impulsivity [RR].

A study (DB-RCT) of 287 adolescents found that Adderall significantly improved hyperactivity/impulsivity in these patients [RR].

Improving impulse control can also help decrease weight [R].

7) Adderall Decreases Hyperactivity and Aggression

Adderall decreases hyperactivity in children with ADHD [R].

In a study (RCT) of 18 children suffering from hyperactivity and aggression, Adderall decreased symptoms in 14 of the children. The other drug tested, methylphenidate only worked in 11 of the children and produced more unwanted side effects [R].

Adderall vs. Ritalin

Adderall relieved symptoms (negative behavior, academic productivity, etc.) better than another commonly prescribed stimulant, Ritalin (methylphenidate). This effect was seen especially at low doses.

Adderall’s effects also last longer throughout the day, sometimes up to twice as long in higher doses. Doctors prescribe Adderall three times more often than Ritalin [R].

When comparing Adderall to Ritalin (methylphenidate) in a study (DB-RCT) of 58 children, Adderall worked better and lasted longer [R].

Adderall Abuse (Non-Prescribed Use)

Due to the normalization of Adderall use, many users see Adderall as not dangerous. In a student university survey, only 2% of users thought Adderall was “very dangerous.” Up to 81% of users saw Adderall as “not dangerous at all” or “slightly dangerous” [R].

Abuse rates have been increasing in adults. Patients over 55 years of age that have been sent to the ER for amphetamine abuse has increased 700% from 1995 to 2002. The number of adults that will need treatment for amphetamine misuse is estimated to rise from 1.7 million in 2000 to 4.4 million in 2020 [RRR].

Adults are at higher risks of abusing Adderall due to the fact that it takes longer to be cleared from the body [R].

In a survey of non-prescription Adderall student users, 93.5% used Adderall and other stimulants to increase focus when studying [R].

Students who abuse Adderall report [RRR]:

  • Improvements in mood
  • Motivation to work
  • Less time needed to accomplish tasks
  • Increased physical and mental energy

There is very little scientific evidence supporting the fact that Adderall improves cognitive performance in non-prescription users. A study (DB-RCT) of 46 volunteers found that Adderall had no effect on memory, creativity, intelligence, or standardized testing, but the volunteers believed that they were improving [R].

Believing that Adderall can improve cognitive performance may, in fact, help some people simply by increasing self-confidence. Therefore, even if there is no actual cognitive boost, the belief that there may be can improve performance [R].

This misconception is the reason why many people still use Adderall for schoolwork, stock trading, surgery, athletics, etc. [R].

People may also abuse Adderall for weight loss. In a study (DB-RCT) of 56 children and adolescents, weight loss was the most common side effect [RR].

Side Effects

If these symptoms occur after taking Adderall, contact your doctor immediately [RR]:

  • Seizures (convulsions)
  • Changes in vision or blurred vision
  • Pupil dilation (mydriasis)
  • Allergic reactions
    • Symptoms can include itching or hives, swelling of the mouth, face, or hands, difficulty breathing, feeling like you are about to pass out, or tightness in the chest
  • Anxiety
  • Fever or sweating
  • Muscle problems such as spasms or twitching
  • Nausea, vomiting, or diarrhea
  • Hallucinations (visual and auditory)
  • Chest pain
  • Fainting
  • Extreme energy
  • Confusion
  • Agitation
  • Unusual mood or behavior
  • Signs of heart problems (can be fast, slow, or uneven heartbeats)
  • Signs of circulation problems (unexplained bruises, numbness, cold, color changes, or pain in fingers or toes)

The following side effects are not as severe but occur more frequently [R]:

  • Dry mouth
  • Dizziness
  • Headache
  • Loss of appetite
  • Weight loss
    • Weight loss can be countered through other medications such as cyproheptadine or through a higher caloric diet [R].
  • Insomnia
  • Stomach pain

Adderall may decrease short-term memory [R].

It may also lead to antisocial feelings, keeping users from enjoying or participating in interactions with others [R].

Adderall use can cause dependence, which can then lead to withdrawal symptoms when medication is ceased. Withdrawal can lead to [R]

  • Cravings
  • Fatigue
  • Depression
  • Social dysfunction

Some of the mental side effects occur due to too much dopamine in the brain. In a study of 14 patients, 12 patients dependent on amphetamines developed psychosis. This brought about schizophrenic-like paranoia and intense hallucinations [RR].

Adderall use by athletes may be dangerous as it increases body temperatures, which may cause heat stress, especially when they exercise for long periods of time because they are not feeling the symptoms of exhaustion and fatigue [R].

Adderall May Increase Your Risk of Heart Problems

One of the most dangerous side effects can be a heart attack or stroke. Patients with a personal or family history of heart conditions are at a higher risk of developing such complications [RR].

The heart problems may be brought about by changes in heart rate and blood pressure that are seen following Adderall consumption. On average, Adderall increases heart rate 1 to 2 beats per minute. As the dose is increased, heart rate increases respectively [RR].

Adderall stimulates β-adrenergic receptor sites all over the body, which causes the release of norepinephrine. Norepinephrine is responsible for increasing heart rate and blood pressure [RR].

Because Adderall can increase heart rate, it is advised to take an electrocardiogram before proceeding with therapy. Heart attacks have only been reported in patients who have not been investigated for heart issues before being prescribed Adderall [R].

Although rare, combining alcohol and Adderall may lead to a heart attack [RR].

Contraindications and Risk of Use

The contraindications of Adderall are [RR]:

  • High blood pressure or other cardiovascular problems
  • Severe anxiety
  • Glaucoma
  • Tourette’s syndrome (muscle twitches, otherwise known as tics)
  • Depression
  • Frequent seizures
  • History of drug abuse
  • Overactive thyroid
  • Allergies to Adderall or other amphetamines

People that have had recent disorders that have caused the narrowing of the gut or liver damage should also stay clear of Adderall use [R].

You should ask your doctor before taking Adderall if you have any of these conditions [R]:

  • Pregnancy/breastfeeding
  • Heart or blood vessel diseases
  • Kidney disease
  • History of heart attack, stroke, or seizure
  • Self-history or family history of depression or mental health problems

Tell any doctor or dentist you see that you are on Adderall, as it can affect certain medical results [R].

Drug Interactions

Combining Adderall and monoamine-oxidase inhibitors (MAO-I) can be dangerous. Combining these two substances can result in [R]:

  • Agitation
  • Muscle spasms (hyperkinesis and opisthotonus)
  • Fever (of up to 109.4℉)
  • Coma
  • Convulsions

After taking an MAO-I, it is advised to wait 14 days before taking Adderall [R].

Adderall may also interfere with any of these drugs/medicines. Ask a doctor about using Adderall if taking [R]:

  • Acetazolamide
  • Ammonium chloride
  • Buspirone
  • Chlorpromazine
  • Ethosuximide
  • Fentanyl
  • Glutamic acid
  • Guanethidine
  • Haloperidol
  • Hydrochlorothiazide
  • Lithium
  • Meperidine
  • Methenamine
  • Phenobarbital
  • Phenytoin
  • Propoxyphene
  • Quinidine
  • Reserpine
  • Ritonavir
  • Sodium acid phosphate
  • St. John’s Wort
  • Tramadol
  • Tryptophan supplements
  • Allergy medicine
  • Antacids
  • Cimetidine
  • Esomeprazole
  • Omeprazole
  • Pantoprazole
  • Sodium bicarbonate
  • Blood pressure medications
  • Despirimine
  • Fluoxetine
  • Paroxetine
  • Protriptyline
  • Migraine medications

Taking vitamin C or juices high in vitamin C may decrease the effectiveness of Adderall [R].

A study (RCT) of 18 subjects given Adderall and alcohol indicated that Adderall is not effective in eliminating the intoxicating effects of alcohol. The combination of substances did not improve driving and traffic violations were not decreased by taking Adderall [R].

In fact, in another study (SB-RCT) of 25 male volunteers, driving skills were significantly decreased when given Adderall [R].

Dosage

There are two ways to take Adderall. When storing the tablets, they should be in a closed container away from direct sunlight, heat, or moisture and kept at room temperature [RR]:

  • Extended-release capsule (Adderall XR): When taking Adderall in this form, it is advised to take the capsule in the morning, otherwise insomnia may occur at night. The pill can be taken with or without food, but it must be taken the same way each time. XR tablets should be taken once a day. They peak at 4 to 7 hours and last around 12 hours.
  • Regular tablet (Adderall IR): Make sure to follow the medication guide that comes with the prescription. It is advised to take the tablet in the morning or early afternoon, otherwise, insomnia may occur at night. IR tablets are usually taken twice a day. They show effects after 45 to 60 minutes and peak at 2 to 3 hours.

If a dose is missed but it is close to the time to take the next dose, then wait until then and take the dose. Otherwise, take the dose as soon as you remember. Do not “double-up” to account for a missed dose [R].

The different doses of Adderall sold are 5mg, 10mg, 15mg, 20mg, and 30mg. They may be in tablet form or the extended release form. Extended-release tablets are labeled Adderall XR while instant release tablets are labeled Adderall IR [R].

Children should not be given more than 30mg per day for XR tablets. Adults should not take over 20mg XR a day, as there is lack of evidence in adults that support the use of higher doses [R].

User Experiences

The increasing use of Adderall by students is due to this growing belief that Adderall can help improve focus, attention, and memory. In a survey of 90 students, over 90% said that Adderall helped them concentrate better and stay awake [RR].

Most patient experiences seem to say that Adderall helps with their disabilities whether it is for narcolepsy or ADHD, which is not surprising due to the high efficacy rates in clinical trials.

People that use Adderall for ADHD say that it helps them focus in class. They also say that it is obvious to other people when they are not using Adderall.

According to users, school grade point averages went up following Adderall use. One user mentions how he used to use Concerta (Ritalin/methylphenidate) for ADHD, but that Adderall was much better.

However, there are some negative experiences as well.

One user had been taking Adderall from ages 12 to 25 and reported that when he stopped taking the drug, it made him very anxious and ruined his professional career. He developed an alcohol and cocaine problem due to Adderall withdrawal.

Another user just says that (s)he is “going crazy” from Adderall use.

Adderall users for narcolepsy are also fairly supportive of the drug. They say that it helps them to do everyday things like staying awake in class, driving, doing homework, etc.

Some users simply say that Adderall has no effect on their narcolepsy and that they still feel tired throughout the day.

Some people complain about building tolerances, which causes them to increase the dose. This leads to more side effects.