Psychosis linked to ADHD medication on the rise, psychiatrists warn

Psychiatrists are reporting more cases of stimulant-induced psychosis than a decade ago. ADHD diagnoses have risen and the number of Australians using stimulant medication is surging. The Australian Society of Psychiatrists’ executive director, Dr Pramudie Gunaratne, said the condition was rare 10 years ago but is now a regular presentation.

ADHD affects an estimated 2 to 6 per cent of Australian adults. The number of adults being treated for the condition has increased more than sixfold since 2017, according to research by the University of New South Wales. Stimulant medications can be transformative for people with ADHD, and Gunaratne said they carry significant risks.

“If you’ve increased the number of people being prescribed this medication, there’s going to be a certain proportion of those people that will develop psychosis,” she said. “If you take more than prescribed, if you take it without medical supervision, if people are accessing stimulants from friends, that can put them at particularly high risk.”

Sydney psychiatrist Dr Matthew Large, a conjoint professor at UNSW, said he is treating an increasing number of patients for psychosis linked to ADHD medication. He has seen four cases in the past year, including a young patient who experienced psychosis after being prescribed stimulants for inattention that was linked to trauma. “The patient instead needed treatment for post-traumatic stress disorder,” he said.

In another case, a high-achieving student feigned ADHD symptoms to obtain medication to improve academic performance and later experienced psychosis after increasing the dose. Large said too few patients are informed of the risk before starting treatment and that safety evidence has not kept pace with prescribing practice.

“The practice has outstripped safety evidence, in my view,” he said.

Associate Professor Mark Putland, Victoria branch chair of the Australasian College for Emergency Medicine, said misuse of ADHD medication was triggering psychosis in some patients, but others using the medication as directed had also developed the condition. He said combining ADHD medication with other substances was fuelling the problem.

“They might be abusing prescribed stimulants and also using some amphetamines they bought on the street, and they might also have some mental health conditions. It’s often messy,” he said.

ADHD Australia chief executive Melissa Webster, who has ADHD, said she knows at least four people who have experienced psychosis while using stimulant medication. She said these people also had pre-existing mental health conditions, making it difficult to determine the cause. Better communication of side effects was needed, she added.

The warnings come as more states allow GPs to diagnose, treat and prescribe ADHD medication, a change designed to reduce the cost of obtaining a diagnosis. Last week, 150 Victorian GPs started prescribing, following similar moves in New South Wales, South Australia and Queensland.