Author: Nancy Swezey, RN

Adderall is in a class of drugs called stimulants. They are so named because they stimulate your central nervous system. Medications similar to Adderall include:

• Methylphenidate (Ritalin, Concerta)
• Dextroamphetamine (Dexedrine)
• Sibutramine hydrochloride monohydrate (Meridia)
• Lisdexamfetamine (Vyvanse)

Adderall is approved by the U.S. Food and Drug Administration (FDA) to treat attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. It comes in 5-30 mg tablets, as well as in extended-release (XR) capsules. For the non-extended release tablets, peak concentration in your bloodstream comes about 3 hours after taking it.

Adderall XR is released in intervals and has a more even and sustained release than the regular tablets.^1,2 Adderall is usually taken 2-3 times a day, while Adderall XR is usually taken only once in the morning.³

A Brief History of Adderall

Adderall initially came out as an ADHD medication in 1994. ADHD was then known as attention deficit disorder (ADD). Adderall’s name was meant to imply “ADD for all.” Before that, it was a weight-loss drug called Obetrol.

Obetrol was taken off the market in 1974 when more laws were coming into place to control the use and misuse of stimulants.⁴ Adderall is today the most commonly prescribed type of stimulant.⁵

Use of Adderall

FDA-Approved Use

ADHD, as the name implies, consists of excessive inattention or hyperactivity. It is considered a disorder related to brain development, and thus it frequently begins during childhood. Inattention includes lack of focus, persistence, and organization, while hyperactivity is excessive movement and fidgeting, particularly when stillness is appropriate. The symptoms of ADHD must interfere with normal social, education, or professional goals to warrant a diagnosis.⁶

Adderall can also be used to treat narcolepsy, a sleep disorder of the central nervous system that involves a sudden onset of sleep, especially after intense emotions such as anger or laughter. Similar to ADHD, if you have narcolepsy, you will experience disruptions to your daily life related to the disorder.⁶

Off-Label Use of Adderall and Other Stimulants

Adderall is often prescribed off-label or is used to self-medicate. Off-label use means that it can be prescribed at a provider’s discretion for uses other than that approved by the FDA and the manufacturer. Self-medicating is if you take medications not prescribed to you to treat a self-diagnosed condition or enhance your performance somehow. Off-label use of Adderall includes:⁵

• Fatigue
• Depression
• Obesity
• Cognitive enhancement

It is not uncommon for Adderall to be prescribed off-label. Only 63% of adolescents and 34% of adults with stimulant prescriptions had ADHD between 2006 and 2009.⁵ Similarly, Adderall is considered a drug with a high potential for recreational use and misuse. For this reason, it has drawn quite a bit of controversy.⁷

Adderall Side Effects

Side effects of Adderall use include:^1,7

• Loss of appetite
• Insomnia
• Weight loss
• Increased heart rate
• Increased blood pressure
• Blurring vision
• Aggression
• Restricted blood flow to extremities
• Hallucinations or delusions
• Seizures

Because of the risks of more severe side effects, it is important to consider your health history before taking Adderall or similar medications. Providers should take precaution, and avoid if possible, prescribing Adderall for people with:¹

• History of delusions or hallucinations
• Bipolar illness
• Known issues with aggression
• Heart problems
• Tics or Tourette’s Syndrome
• Ongoing issues with high blood pressure
• Hyperthyroidism
• Allergy to Adderall-like medications
• Glaucoma
• History of drug misuse

Adderall can cause stroke, heart attack, or sudden death if you have any heart abnormalities.² You should not take Adderall if you have been experiencing ongoing agitation or have taken any monoamine oxidase inhibitors (MAOIs), a type of antidepressant recently.¹

Prescribers are advised to prescribe the minimal effective dose of Adderall to avoid long and short-term negative effects of Adderall.

According to the manufacturer, the outcomes of long-term use of Adderall have not been studied. Even if you have ADHD or narcolepsy, it’s recommended that you are reassessed frequently to determine the usefulness and necessity of the medication.¹

Adderall Addiction and Misuse

Adderall is a controlled substance, meaning the government oversees its distribution to limit overproduction and overuse. It is ranked as a Schedule II drug by the U.S. Drug Enforcement Agency, which means that it is controlled due to its potential for psychological and physical dependence.⁸

One reason that Adderall has drawn concern and negative attention is this propensity for misuse. Adderall and other stimulants can cause an overload of neurological chemicals in your brain if you do not medically need it.¹⁰ The chemical changes of Adderall and other stimulant highs can involve:⁶

• Becoming more talkative and outgoing
• Feeling restless
• Anxiety
• Vigor
• Interest in, and awareness of, others
• Repetitive behavior
• Impaired judgment

After repeated use, chronic Adderall intoxication can lead to:⁶

• Heart problems
• Social withdrawal
• Nausea and vomiting
• Dilated pupils
• Seizures
• Confusion
• Weakness
• Ringing in your ears
• Psychosis

If you or someone you know is addicted to Adderall, treatment programs are available. Adderall addiction treatment can help address the underlying reasons for your stimulant abuse and provide you with the coping skills you need to avoid relapse.

Stimulant Use Disorder

Misuse of Adderall, cocaine, crystal meth, speed, and other stimulants fall under the umbrella of “stimulant use disorder” by the American Psychiatric Association.⁶ It can develop in as little as a week after repeatedly using stimulants like Adderall, although it doesn’t always happen that quickly.

A diagnosis of stimulant use disorder is warranted if you have at least some of the following experiences related to stimulants within a one-year period:⁶

• Taking larger amounts than intended, or over a longer period
• Persistent, unsuccessful efforts to cut down on use
• A lot of time spent getting, using, or recovering from it
• Failure to meet personal or work responsibilities as a result of use
• Cravings
• Continuing use even after problems related to use
• Dangerous situations
• Relationship problems
• Needing more to achieve the same high
• Taking it to avoid withdrawal
• Experiencing withdrawal

Ritalin vs. Adderall

Ritalin is a well-known medication similar to Adderall. It has a different chemical makeup than Adderall, but it is used to treat the same conditions and has a lot of the same properties. Together they are two of the most prescribed medications for ADHD.

One significant difference is that because of their makeup, Ritalin has a less abrupt onset of action, a longer duration of action. It is less likely to cause the “crash” that many Adderall users experience. Some research shows that Adderall has a higher potential for addiction.

Because they are so similar, they should be used with caution, as they can both lead to negative outcomes.³ If you do need to be on a medication like Ritalin or Adderall, prescribers can help you choose the best medication for you.

Adderall Use and Mental Illness

It is important to speak to your doctor about your Adderall use, even if it is not prescribed. Without knowing about your stimulant use, your provider may not be able to diagnose your symptoms.

Adderall intoxication and withdrawal can both mimic mental illnesses including:⁶

• Generalized anxiety disorder
• Panic disorder
• Mania of bipolar disorder
• Psychosis or schizophrenia
• Depression

Popularity of Adderall Use in Young People

Considering that ADHD is a childhood brain disorder, it is not surprising that many children and adolescents are prescribed Adderall. Today, more than 10% of children are diagnosed with ADHD. Of that 10%, most of them, or 60-70%, take an ADHD medication, like Adderall.⁹

Because Adderall is often prescribed to children with ADHD, it is important to consider its effects on normal growth. Adderall is known to suppress appetite, so it is not uncommon for Adderall users to lose weight. If this happens in growing healthy children, it could suppress normal growth. Providers are advised to stop treatment with Adderall if this happens, as it can be irreversible.¹

ADHD and Substance Use Disorder

Considering the propensity for misuse and recreational use of Adderall, many providers practice caution before diagnosing ADHD and prescribing Adderall. Some have shown concern that patients mimic ADHD to get a prescription for stimulants.

Adderall is not recommended if you have a history of substance misuse.¹ It can be challenging at times to parse out the differences between ADHD and substance use disorder, as many of their symptoms overlap. Some of the overlapping symptoms include:¹¹

• Impulsivity
• Unstable moods
• Emotional imbalance
• Inability to delay gratification

In many cases, people have both substance use disorder and ADHD. If you have both, it may be harder to abstain from addictive substances, and you may have higher risks of adverse events than others.

It’s important to find a provider that can be sensitive to your needs and treat your conditions with your safety and wellbeing as the utmost goal. Call 800-934-1582(Who Answers?) to speak with a treatment specialist.

References

1. Shire US Inc. (2013). Adderall XR. Wayne, PA.
2. Teva Pharmaceuticals. (2017). Adderall® CII (Dextroamphetamine Saccharate, Amphetamine Aspartate, Dextroamphetamine Sulfate and Amphetamine Sulfate Tablets). Horsham, PA.
3. Sherzada, A. (2012). An analysis of ADHD drugs: Ritalin and Adderall. JCCC Honors Journal, 3(1), 2.
4. Schwarz, Alan (14 December 2013). “The Selling of Attention Deficit Disorder.” The New York Times.
5. Brief, E. Emerging Trends in Prescription Stimulants Indicated for Treatment of Attention-Deficit/Hyperactivity Disorder: Mississippi, 2011 and 2014.
6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
7. Heal, D. J., Smith, S. L., Gosden, J., & Nutt, D. J. (2013). Amphetamine, past and present–a pharmacological and clinical perspective. Journal of psychopharmacology, 27(6), 479-496.
8. List of Controlled Substances. (n.d.). US Drug Enforcement Agency & Department of Justice.
9. Colaneri, N., Keim, S., & Adesman, A. (2017). Physician practices to prevent ADHD stimulant diversion and misuse. Journal of substance abuse treatment, 74, 26-34.
10. Rasmussen, N. (2015). Amphetamine-type stimulants: the early history of their medical and non-medical uses. International review of neurobiology, 120, 9-25.
11. Varga, M. D. (2012). Adderall abuse on college campuses: a comprehensive literature review. Journal of evidence-based social work, 9(3), 293-313.