Adderall is a prescription medication used to treat attention deficit hyperactivity disorder (ADHD) and narcolepsy. Adderall, a brand name, is a combination of amphetamine and dextroamphetamine, which are central nervous system stimulants. Taking Adderall may help increase the ability to focus, pay attention and control behavior.
The drug increases the synaptic concentration of dopamine and norepinephrine by blocking the reabsorption of a neurotransmitter, said Dr. Maria Pino, a toxicologist and course director for pharmacology at Touro College of Osteopathic Medicine in New York. This drug mainly stimulates the sympathetic nervous system, which triggers the body's fight or flight responses, such as dilation of the pupil of the eye, increased blood pressure and heart rate and increased sweating.
Identification of Adderall
Adderall is available as a tablet and as an extended-release capsule (Adderall XR). It comes in varying doses, depending on the size of the patient and the severity of symptoms. Dosages are recognizable by their varying shapes, colors, and sizes:
- Adderall 5 mg – white to off-white tablet, round, flat-faced beveled edge tablet
- Adderall 7.5 mg – blue tablet, oval, biconvex
- Adderall 10 mg – blue tablet, round, biconvex
- Adderall 12.5 mg – peach tablet, round, flat-faced beveled edge
- Adderall 15 mg – peach tablet, oval, biconvex
- Adderall 20 mg – peach tablet, round, biconvex
- Adderall 30 mg – peach tablet, round, flat-faced beveled edge
According to the National Institutes of Health, the tablet is usually taken two to three times daily; the extended-release capsule is usually taken once daily.
Dextroamphetamine and amphetamine may cause side effects, including:
- Difficulty falling asleep or staying asleep
- Uncontrollable shaking of a part of the body
- Changes in sex drive or ability
- Dry mouth
- Stomach pain
- Loss of appetite
- Weight loss
Some side effects can be serious, and the NIH says that anyone who experiences any of these symptoms should call their doctor immediately:
- Fast or pounding heartbeat
- Shortness of breath
- Chest pain
- Excessive tiredness
- Slow or difficult speech
- Dizziness or faintness
- Weakness or numbness of an arm or leg
- Motor tics or verbal tics
- Believing things that are not true
- Feeling unusually suspicious of others
- Hallucinating (seeing things or hearing voices that do not exist)
- Mania (frenzied or abnormally excited mood)
- Aggressive or hostile behavior
- Changes in vision or blurred vision
- Blistering or peeling skin
- Swelling of the eyes, face, tongue, or throat
- Difficulty breathing or swallowing
Who should not use Adderall
Adderall is not for everybody. It should not be used by patients with a history of glaucoma, severe anxiety or agitation, a personal or family history of tics, or Tourette syndrome. Stimulants can also cause sudden death in patients with congenital heart defects or serious heart problems. As a result, patients should alert their doctors if they have a history of heart disease, heart rhythm disorder, coronary artery disease or heart attacks. Doctors should also be alerted if the patient has a history of high blood pressure, mental illness, peripheral vascular disease or seizure disorders.
Some drug interactions could be harmful. The NIH says that people should not take Adderall if they have taken an MAO inhibitor in the last two weeks.
Adderall & children
For children with ADHD, or hyperactive-impulsive or inattentive symptoms that cause impairment and appear before the age of 7, Adderall can be considered part of a total treatment program. ADHD must be diagnosed through a series of tests that rule out other mental disorders. Other treatment measures will include psychological, educational and social aspects — drug treatments may not even be necessary.
Adderall is not intended for use in children who exhibit symptoms that are secondary to environmental factors or exhibit symptoms that indicate primary psychiatric disorders. When all other options have been exhausted, physicians will prescribe Adderall at doses that vary based on the severity of symptoms.
The long-term use of Adderall has not been evaluated in controlled trials, so it is to the discretion of the physician how long the child should take the drug. There is evidence that children ages 7-10 who were constantly medicated have a temporary slowing in growth rate.
Abuse & addiction to Adderall
Adderall is a Schedule II controlled substance, which means there is a high risk for addiction or abuse, which is why any usage should be closely monitored by a medical professional. “When taken as prescribed by a physician, there is little risk of addiction, but if taken recreationally for the "euphoric" effect, the risk of abuse will be enhanced,” said Pino. “This is due to increased dopamine in the nucleus accumbens" area of the brain, which reinforces behavior.
Amphetamines are extensively abused, according to the Food and Drug Administration. “Adderall has become one of the mainstay drugs at many party events both on campus and off because it is cheap and easy to access,” said Dr. Marc J. Romano, assistant medical director at Ocean Breeze Recovery in Pompano Beach, Florida. “Adderall’s appeal is the surge in energy that results when taking this drug along with a more subdued euphoric effect.”
This medication should not be sold or shared; doing so is not only dangerous, but also illegal. There is evidence that abuse of this drug may be related to an increase in emergency room visits involving prescription stimulants. A 2016 study published in The Journal of Clinical Psychiatry found that nonmedical use of Adderall by adults had gone up by 67.1 percent and emergency department visits involving the medication had gone up by 155.9 percent. However, the authors concluded that more research is needed to confirm the relation between the two trends.
Amphetamine and dextroamphetamine can be habit-forming. According to the Mayo Clinic, simply taking too much Adderall can cause dependence. People using Adderall should not take a larger dose, or take it more often or for a longer time than prescribed by a doctor. Also, abruptly stopping the medication can cause depression, fatigue and sleep problems.
Adderall is often taken by crushing it and snorting it to intensify the high. “The irony with snorting Adderall is that when taken as intended, orally, it is more effective,” said Romano. “Adderall taken orally gets into the bloodstream more efficiently thereby having a direct effect on the central nervous system, which results in the desired effects of increased energy, alertness, and euphoria and the effects tend to last longer.”
When snorting Adderall, side effects include respiratory problems, such as the destruction of the nasal and sinus cavities and lung tissue; irregular heartbeats; problems with circulation; psychotic episodes; increased aggression; and toxic shock. Prolonged use can cause developmental problems with the brain, negative changes in brain activity, and severe withdrawal problems like depression, psychosis, restlessness and agitation. Abusing the drug can also be fatal.
Adderall with alcohol
Romano also noted that individuals often report using Adderall when drinking alcohol to offset the effects of the latter drug. They feel that they do not get as drunk as they would when taking Adderall. Individuals may drink more alcohol when taking Adderall, though, which can result in serious impairment, including death from alcohol poisoning.
Adderall as a “smart drug”
There is a rising trend of college students abusing Adderall and similar drugs, like Ritalin, to perform better on tests and papers. A study by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that full-time college students were twice as likely as non-students to have used Adderall non-medically. Affordable at roughly $6-$8 street value, it is easy for college students to get their hands on Adderall illegally. There is no evidence that Adderall has any effect on studying or test taking, according to the University of WisconsinMadison.
Some people — especially college students — take Adderall as a diet pill. Adderall can cause weight loss because amphetamine speeds up the body's metabolism and lowers appetite. However, it also speeds up the heart and can cause irregular heartbeat and even cardiac arrest.
Any weight loss due to Adderall would likely be temporary. Weight gain would probably occur after stopping the use of Adderall, according to the University of Wisconsin Madison.
Long-term abuse & overdose
Chronic abuse is marked by severe rash, insomnia, irritability and personality changes. The most severe symptom of abuse is psychosis, which is often clinically indistinguishable from schizophrenia. Signs of addiction include:
- Developing a tolerance and needing a higher dosage to get the same effect
- Needing a “quick fix” is frequent
- Snorting, smoking or injecting for faster effects
- The user needs Adderall to feel normal and to deal with everyday situations.
- Loss of control and the need to get high at any cost.
- The user continues to abuse the drug despite negative consequences.
Toxic symptoms from taking an overdose of Adderall can come at low doses. Initial signs of an overdose include restlessness, tremor, confusion, hallucinations and panic states. After this central stimulation, the patient will undergo fatigue, depression, and often cardiovascular and gastrointestinal symptoms. The NIH says that people should contact a medical professional immediately if they suspect that they or someone they know has overdosed on Adderall.
Additional reporting by Alina Bradford, Live Science Contributor.