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It’s easy to see the appeal of a pill that keeps you in the zone in our hyper-focused, fast-paced, always-connected world.
That’s why it’s probably no surprise that by most measures, both legal and illegal usage rates of prescription stimulants like Adderall, Ritalin, Concerta, and Vyvanse (or the generic forms of some of these drugs) continue to remain stable or rise for everyone from young children to adults in the workplace and even among the elderly.
For people with ADHD, these drugs can be lifesavers. But as we know, many others are tempted by potentially cognitive enhancing drugs too, even if there are big questions about whether or not they work. We don’t get enough sleep and everyone from students to office workers is trying to get an extra boost.
But before you jump on the bandwagon, here are some facts about Adderall and other stimulants you should know.
First of all, you should (and legally have to) talk to your doctor before getting Adderall.
Adderall, Ritalin, and similar medications are Schedule II drugs, which have medical uses but also have a high potential for abuse that can potentially lead to dependence — they should only be taken after a consultation with a doctor.
They are generally prescribed to treat attention-deficit hyperactivity disorder. The way your body responds to the drug may depend on whether you actually have ADHD, according to some research.
However, there isn’t a simple test that determines whether a person definitely has ADHD.
To make that diagnosis, your doctor or mental health provider may ask questions to see whether you have a certain number of the 18 ADHD symptoms listed in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) — they check for six symptoms in people 16 and younger and five symptoms of inattention or hyperactivity for anyone older. A doctor who decides that those symptoms aren’t caused by something else may prescribe a stimulant to see whether that helps.
If you like the feeling of Adderall or Ritalin, you may be less likely to have ADHD.
A 2014 study had the surprising finding that people who were genetically predisposed to feel euphoria when on stimulants were also less likely to have genes that predisposed them to ADHD and schizophrenia.
This might explain why some people who don’t have ADHD may be especially likely to abuse stimulants — it makes them feel particularly good. Still, that’s probably not the prime factor that drives abuse. A recent study found that the best predictor of stimulant misuse among adolescents was the use of other mind-altering drugs like alcohol, tobacco, or marijuana, which the researchers say indicates there’s a strong social component.
More and more adults are getting prescriptions for ADHD medication.
Between 2007 and 2012, the number of adults with ADHD prescriptions roughly tripled.
In 2007, there were 5.6 million monthly ADHD prescriptions for people aged 20 to 39. By 2012, that number approached 16 million.
The number of adults who have an ADHD prescription is now rising faster than the number of new prescriptions for children getting the same drugs. Some reports indicate that despite any concerns about overuse of stimulants, there was a 5.9% increase in prescribed stimulant use from 2014 to 2015, mostly driven by more use among adults.
Stimulants might provide some cognitive enhancement in people with adult ADHD.
Among adults, a study showed that ADHD subjects who regularly took medication performed better on an IQ test than ADHD adults who were unmedicated.
Researchers say their higher scores could mean that their medication helped them do better on the test, or it could mean that the adults who would have done better on the test anyway were the same ones who would have sought out treatment.
Part of the confusion comes from the fact that we don’t know exactly how these drugs work. They increase neurotransmitter activity, but it’s hard to fully understand how that affects cognition.
Other research shows that stimulants don’t necessarily provide cognitive enhancement in kids.
Although stimulants help people focus and pay attention, they don’t necessarily improve academic performance in students with ADHD.
They may help people sit still longer and lessen disruptive behavior in class, but few direct cognitive improvements have been shown.
If you are creative, stimulants could impair your abilities.
In one study, researchers had a small group of young adults perform a series of tasks related to creativity to see the kind of impact Adderall might have.
Adderall didn’t affect performance on all tasks, but on the tests in which it did have an effect it seemed to help those who were low-performing.
However, people who had performed well on the test without taking stimulants showed either no change or did worse while taking Adderall.
ADHD drugs can be addictive.
Drugs like Adderall and Ritalin release a rush of dopamine and other neurotransmitters in the brain, giving many people a sense of euphoria.
They help people feel alert, awake, and focused, but they also make it hard to sleep — making it more tempting to take another pill when you’re exhausted the next day.
People also develop a tolerance to these drugs, requiring more and more over time to achieve the same effect. Stimulants are considered habit forming or addictive because it can be easy to become dependent on them.
Stimulant-related emergency-room visits have risen significantly in recent years.
Though some don’t see them as drugs, stimulants — methylphenidate or amphetamines like speed — carry real risks.
Emergency-room visits for people 18 to 34 attributed to nonmedical stimulant use tripled from 2005 to 2011, though those numbers also include things like caffeine pills.
A 2016 study out of Johns Hopkins School of Public Health found that ER visits for adults related to Adderall misuse rose 156% from 2006 to 2011.
Stimulants like Adderall elevate blood pressure and speed up your heart.
Stimulants can cause circulatory problems and constrict blood vessels, leading to increased blood pressure.
This can increase the risk for a heart attack or a stroke, and you should contact a doctor if you experience chest pain, shortness of breath, or fainting after taking Adderall.
Drinking while taking Adderall may be even more dangerous.
Lots of college kids and young adults take stimulants like Adderall when they go out, either to stay up or just for the euphoric effect.
But drinking may increase the risk of heart problems for people taking stimulants, even when they don’t take an excessive amount of medication.
In at least one case, researchers documented a heart attack in an otherwise healthy 20-year-old who took 30 mg of Adderall after drinking.
Adderall and other stimulants may increase anxiety.
By increasing heart rate and enhancing the effects of neurotransmitters like dopamine, stimulants can significantly increase anxiety.
This can cause shortness of breath, dry mouth, nervousness, paranoia, and other side effects.
Stimulants can improve memorization skills …
One of the main reasons people take stimulants without a prescription is to do better at school or work.
Although the cognitive benefits of Adderall and Ritalin are far from clear, one thing they do seem to help with is rote learning.
A few studies have shown that people who memorize things while on stimulants may be better at remembering those words or terms when tested later on.
… and there’s some evidence that they can boost working memory, but only very slightly.
A review of different studies on the cognitive benefits or harms of stimulants found limited effects on working memory, the ability to hold and manipulate different pieces of information simultaneously.
That’s not very significant for most people but may provide “a small advantage” in certain situations, which may explain the draw for people who might benefit from a small boost, like eSports players.
Another review found that people who performed poorly on tests to begin with saw the most improved performance, leading researchers to think that stimulants may be better at correcting deficits than at enhancing cognitive abilities.
The placebo effect may account for some of the perceived cognitive benefits of stimulants.
Some research shows that people who think they are going to be given a drug like Ritalin or Concerta don’t show cognitive improvement but do pay better attention and act more engaged.
In a recent study, college students were given either a placebo pill that they thought was Ritalin or no pill before taking a series of cognitive tests.
When they thought they had taken Ritalin, students said they were more alert and able to focus on the work.
Scary side effects include heart attacks and sudden death.
The scariest of the listed side effects for Adderall is the risk of sudden death, along with a series of other heart problems that stimulants can cause.
Most of the sudden-death cases, which are rare, have occurred with people who had structural issues with their heart or other health complications, and at least one fatality involved a toxic level of medication. Another case was associated with vigorous exercise.
Other cardiac side effects include high blood pressure and tachycardia, or a sped-up heart rate.
Every major ADHD drug has been cited by the FDA for false and misleading advertising.
According to The New York Times, the FDA has “cited every major ADHD drug — stimulants like Adderall, Concerta, Focalin, and Vyvanse, and nonstimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times.”
That story quotes experts who argue that marketing — and, in some cases, false marketing — by pharmaceutical companies is behind much of the rise in the number of people taking Adderall, Vyvanse, Concerta, and Focalin.
They note that sales of stimulants have quintupled since 2002 and point to potentially misleading quizzes that let adults test whether they have ADHD. The Times polled more than 1,100 adults and found that more than half scored in a range that said they “possibly” or “likely” suffer from ADHD, suggesting the criteria are far too inclusive.
In rare cases, stimulant abuse has led to mental illness and psychosis.
The FDA’s medication guide to Adderall warns people to call doctors immediately if they experience mental problems, “especially seeing or hearing things that are not real, believing things that are not real, or are suspicious.”
Worsened mental illness for adults and psychotic symptoms for children are among the listed side effects.
The medical literature includes case reports of methylphenidate, the active ingredient in Ritalin and Concerta, triggering depression in a 7-year-old and terrifying hallucinations in a 15-year-old. And The New York Times reported on the highly unusual but tragic case of Richard Fee, a 24-year-old from Virginia Beach. Fee developed very serious mental-health problems while battling a severe addiction to prescription stimulants and ultimately took his own life.
Almost 20% of high school boys have received a diagnosis of ADHD, and more kids are prescribed stimulants than ever before.
A 2013 CDC report showed that the number of kids ages 4 to 17 who received a diagnosis of ADHD rose 41% over the past decade. About two-thirds of kids with a diagnosis are prescribed stimulants like Adderall and Ritalin.
Boys receive ADHD diagnoses at more than twice the rate of girls and are also more likely to receive prescription stimulants. Almost 20% of high school boys have received an ADHD diagnosis.
Some people argue that this reflects better recognition and diagnosis of ADHD, but others say that it’s a dangerous overuse of medicine to calm kids down and help them out in school. A big 2014 feature in Esquire argued that the high rate of ADHD diagnoses among boys in particular is due to both a misunderstanding of boys’ behavior and increased marketing efforts by pharmaceutical companies.
Many people who use Adderall without a prescription don’t think they are taking a drug.
One survey of undergraduates found that only 2% thought using Adderall was “very dangerous.”
Students told researchers that Adderall was “not a drug” but instead “a study tool.”
Others compared it to drugs like cocaine and said Adderall was “kinda the opposite” because they used to be better at school and it was perfectly safe because doctors prescribed it.
Up to one-third of college students use stimulants — and they don’t think it’s cheating.
While it’s hard to estimate illegal or off-label usage of prescription stimulants, one 2014 study showed that almost 20% of Ivy League students used an unprescribed study aid at least once while in college — though those “at least once” rates may not be the best way to measure regular off-label use, which is harder to assess.
Overall, estimates of the percentage of college students who have illegally taken stimulants range from 6.9% to 35.6%.
Of the Ivy League students surveyed, 33% did not view using stimulants as cheating, though 41% did. The remaining 25% were unsure.
Because students don’t consider Adderall use a big deal, they talk about it freely on social media — giving researchers plenty of data to analyze.
People aren’t scared to mention on Twitter that they are using Adderall, and though there are questions about how reliable behavioral information gathered from Twitter is, data scientists are taking note.
Computer science researchers at Brigham Young University analyzed tweets that mentioned “Adderall” between November 2011 and May 2012. There were an average of 930 Adderall-related tweets a day, but that number rose to 2,813 on Dec. 13 and 2,207 on April 30 — a spike the researchers attributed to finals cramming.
And geotagging revealed where people were tweeting about Adderall most: The largest clusters of tweets about Adderall per 100,000 students were near universities in the Northeast and South, a finding that matches previous research on where students are most likely to use “study aids.”
On less public apps like Snapchat or Yeti, which Business Insider’s Julie Bort has explained “is an app where students share photos and videos of college life,” students are perhaps even more open about stimulant use.
Doctors have ignored FDA warnings about prescription stimulants.
FDA warnings that Adderall, Ritalin, and other prescription stimulants are addictive and can have potentially dangerous side effects also haven’t deterred doctors from prescribing them.
Four years after a 2004 FDA advisory about possible cardiac risks, doctors hadn’t significantly changed the way they prescribed stimulants.
Pro baseball players take ADHD meds at rates that are much higher than normal.
Baseball players have historically used stimulants as performance-enhancing drugs.
After Major League Baseball announced a stimulant ban, at about the same time regulators were cracking down on steroid abuse, the number of pro baseball players who requested therapeutic exemptions that would allow them to continue to take stimulants jumped from 28 players to 103, or 8% of the league. The number is now even higher: In 2013, 119 requested those exemptions.
Those rates are more than double the 4% of adults who the National Institute of Mental Health says are affected by ADHD. Some say that professional athletes are more likely to have ADHD than the rest of the population, but not everyone agrees.
“This is incredible. This is quite spectacular,” said Dr. Gary Wadler of the World Anti-Doping Agency, when the MLB ban led to a jump in therapeutic exemptions. “There seems to be an epidemic of ADD in major league baseball.”
Part of the reason the “cognitive enhancing” effects of stimulants like Adderall are unclear is that we don’t have very good tests for them.
Some researchers caution that the reason it’s so hard to say whether these drugs improve cognitive performance is that most of our tests are designed to find impairment, not improvement, in healthy people.
As researchers Oxford researchers Ruairidh Battleday and Anna-Katherine Brem explained to me for a story about Modafinil, another popular drug taken for cognitive enhancement, we don’t really have good tests for cognitive enhancement. That may be why there are conflicting results from different studies assessing the effects of Adderall or other stimulants.
Better tests would tell us far more.
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