New Study Reveals Methylphenidate May Reduce Psychosis Risk in Children with ADHD
A recent large-scale study has uncovered that the stimulant methylphenidate, commonly used in medications like Ritalin and Concerta, may lower the risk of psychosis when prescribed to younger children with attention-deficit/hyperactivity disorder (ADHD). This finding offers new insights into the complex relationship between ADHD treatments and mental health outcomes.
Children diagnosed with ADHD are known to be at a higher risk of developing psychotic conditions such as bipolar disorder or schizophrenia compared to neurotypical peers. Some earlier studies have suggested a potential link between ADHD medications and psychosis, but this new research provides a more nuanced perspective.
Published in JAMA Psychiatry, the study found no significant difference in psychosis risk between children treated with methylphenidate and those who were not. In fact, sustained treatment with methylphenidate for three to four years in children under the age of 13 appeared to reduce the likelihood of psychosis.
Approximately 3.5 million children in the United States aged 3 to 17 are prescribed ADHD medications, highlighting the widespread use of these drugs. The research team from the University of Edinburgh and University College Dublin analyzed the health records of nearly 4,000 Finnish children and adolescents diagnosed with ADHD.
Dr. Ian Kelleher, chair of child and adolescent psychiatry at the University of Edinburgh and the senior author of the study, emphasized that while children with ADHD are at an increased risk of psychosis, this risk is not linked to medication. “That risk would seem to be due to other factors,” he said.
Kelleher proposed that the connection between ADHD and psychosis could stem from shared genetic risk factors between the two disorders, independent of medication. He noted that further research is needed to explore these underlying mechanisms.
Dr. Christian Kohler, professor of psychiatry at the University of Pennsylvania, described the findings as “thought-provoking and not expected.” However, he cautioned that the results do not rule out a possible association in older age groups, particularly in late adolescence or early adulthood.
Kohler highlighted concerns about stimulants increasing dopamine levels in the brain’s limbic system, which is involved in emotional regulation. This could potentially trigger erratic thinking or hallucinations in vulnerable individuals. He speculated that there might be a tipping point, possibly starting in the late teens, where the risk of psychosis increases after stimulant treatment.
“What if you’re diagnosed with ADHD at 16 or 17 and you’re being put on a stimulant?” Kohler asked. “As clinicians, we see, not infrequently, people experiencing some cognitive dysfunction later in adolescence, being diagnosed with ADHD, put on a stimulant, and then experiencing psychosis within a couple of months.”
Kohler also expressed interest in similar studies focusing on amphetamines, a different class of stimulants used in medications like Adderall. These drugs are more commonly prescribed to adults and privately insured patients. Research has shown that patients on amphetamines are more likely to develop psychosis than those on methylphenidate.
Dr. Jeffrey Newcorn, director of the division of ADHD and learning disorders at the Icahn School of Medicine at Mount Sinai, noted that psychosis risk is generally higher for those prescribed amphetamines. “This study doesn’t say you can’t have amphetamine psychosis,” he said. “It’s very rare with the doses we give, if people take them properly, but it very, very occasionally happens.”
A 2024 study found that high doses of amphetamines, including Vyvanse, significantly increase the risk of psychosis or mania. However, due to the limited use of amphetamines in Europe, the dataset lacked enough children to draw accurate conclusions about their link to psychotic disorders.
Despite these uncertainties, Kelleher agreed that further investigation is warranted. “It’s still a bit of an open question,” he said. “It could be the case that more severe and difficult-to-treat ADHD has more of an overlap, in terms of genetic risk, with psychotic disorders.”
Overall, Kohler believes that factors such as medication dose, timing of treatment, and the stability of the patient’s condition may play a critical role in whether stimulants are protective or contribute to further issues.
He was intrigued by the study’s finding that methylphenidate may have a preventive role in younger children. This aligns with prior research on lab mice and rats, which showed that long-term methylphenidate treatment in juvenile animals normalized abnormalities in dopamine-rich brain regions.
“I think that was really interesting,” Kohler said. “Does it maybe balance or repair an early deficit [in the brain], so that it doesn’t become a risk for developing psychosis later on?”
While many questions remain, the researchers hope this study brings reassurance to parents of children with ADHD. “It’s reassuring that the risk of a serious lifelong psychotic disorder is not increased by [this] medication,” Newcorn said.
