VUlogo

Psychology Department

Health Psychology Home Page

Papers written by students providing scientific reviews of topics related to health and well being

  HomeWeight LossAlternative Therapy | Supplements | Eating Disorders | Fitness | About this Page |

 

ADHD and Adderall®:  Effects on the Heart and Personality?

Ted Gargano

October 5, 2009

 

 

INTRODUCTION

Today, there are many new methods, remedies, and treatments in health psychology that are exploiting the youth of the science as a means to attract the general public.  It is our job as citizens of humanity to question the validity and truthfulness of the claims made by the proprietors of these novel businesses as to the effectiveness and safety of their products.  As an example, I bring forth to you a very common psychological disorder that affects ”3-10% of the general population”( http://www.ncbi.nlm.nih.gov/pubmed/16756025), ADHD, and one of its medications, Adderall®.  As well as provide an effective means for treating the symptoms of ADHD, Adderall® has also been known to have a negative effect on its users’ personality.      

 

WHY ADHD?

As few as 9 million and as many as 30 million people are afflicted with ADHD in the US, a huge number of people, and thus, a huge market for drug companies to penetrate.  Since its designation as an “official” mental disorder in 1980 by the National Institute of Mental Health, ADHD has been a focus of many researchers mainly because of its sheer prevalence in the general population (http://www.add-adhd-help-center.com/newsletters/newsletter_15july03.htm).  Additionally, diagnosis of ADHD has increased about 3% each year between 1997 and 2006 (http://www.cdc.gov/ncbddd/adhd/data.html).   Thus, it is quite natural for drug companies to have expressed an interest in attempting to formulate a remedy and/or treatment for ADHD.  First, however, everyone must understand what ADHD is, what the physiological effects of the disorder are, and how it also affects an individual’s behavior.

(http://cache.consumerist.com/assets/resources/2006/10/pills.jpg)

 

WHAT EXACTLY IS ADHD?    

ADHD stands for Attention Deficit Hyperactivity Disorder, and those who are properly diagnosed are marked by a clear inability to maintain focus for long periods of time.  This is often a problem for young children in school, as well as adults at work.  The lack of attention that ADHD patients suffer is mainly brought about by the abnormal functioning of two major neurotransmitter systems, the dopaminergic and noradrenergic systems (http://www.ncbi.nlm.nih.gov/pubmed/16756025).  Dopamine and noradrenaline (norepinephrine) are excitatory neurotransmitters that have the effect of stimulating the central nervous system and are also linked to feelings of enjoyment, euphoria, and fear.  For example, a commonly experienced phenomenon is the “fight or flight” response that we encounter when we are faced with a relevant or threatening stimulus.  In this response the sympathetic nervous system is activated causing one to react firstly by attending solely to the stimulus, and then the individual makes a decision to deal with it or flee from it (http://www.psychologistworld.com/stress/fightflight.php).  Increased release of dopamine and norepinephrine, although not completely responsible for the fight or flight response does play a major role in our heightened awareness and attention during the phenomenon.  Thus, a lack of attention would seem to be associated with a lack of dopamine and norepinephrine release and/or uptake by neurons.  This understanding, therefore, offered a starting point for drug companies in creating their remedies.

(http://www.thecausewayretreat.com/blog/2009/06/fight-or-flight-response/) (right image)

(http://www.helpyourautisticchildblog.com/date/2008/06/) (left image)

 

WHAT IS ADDERALL®?  WHAT DO WEBPAGES HAVE TO SAY?

Specifically, the drug Adderall® is a mixture of four different amphetamine salts originally designed as a diet drug because of its effects on decreasing the appetite (http://www.associatedcontent.com/article/1268435/adderall_history_uses_side_effects.html?cat=70).  The amphetamine salts in Adderall also work by increasing the levels of dopamine and norepinephrine in the nervous system, which leads to heightened awareness and concentration.  In 1996 Adderall® was available to the prescribed public as an ADHD medication because of the effects of its component amphetamines on the neurotransmitter systems that function abnormally in ADHD patients (http://www.adderall.net/).  Many of the pro-Adderall® websites distinguish it as a “miracle drug” because of its clear ability to greatly improve the attention of ADHD patients.  Ideally, an ADHD patient prescribed to the drug may use the drug, and by way of the mechanisms previously described, will be able to pay better attention to the tasks at hand.  Eureka! We have found the cure for ADHD!  It is not that simple, however.  As with any drug, Adderall® and other ADHD medications come with many potentially harmful side effects which, many of the websites fail to consider.  However, there are a vast number of web pages that do discuss concerns about the negative complications of using Adderall®, and their discussions are very thorough and parallel with one another. 

 

 

AMPHETAMINES:  A PROBLEM?

Amphetamines are also commonly known as “speed” because of their effect of increasing awareness and wakefulness.  Users often appear to be extremely active and responsive hence, the street name “speed.”  An illegal variant of the “basic” amphetamine known as crystal methamphetamine is commonly abused.  Crystal methamphetamine, or “meth,” is very dangerous in that it is extremely addictive, and long term use may lead to many life threatening physiological side effects.  It is often referred to as “the single most dangerous drug on earth.”  Meth’s addictive qualities come from its component amphetamines which activate the “reward centers” of the brain, causing the user to want more (http://www.recoveryconnection.org/drug_index/methamphetamine.php).  It is for this reason that Adderall® acts as a double-edged sword.  Although drug treatment of ADHD with stimulants (Adderall®) provides a convenient and effective means of controlling some of the negative behaviors associated with ADHD, the addictive qualities of its constituent amphetamines can be very dangerous.  It is critical that an individual be well informed about the possible side effects associated with stimulant usage.

(http://www.monheit.com/adderall/aderall_image.gif)

 

ADDERALL®:  CARDIOVASCULAR SIDE EFFECTS   

Some of the most concerning side effects of stimulant usage are those that affect cardiovascular systems of the body.  Some of these side effects include heart palpitations and tachycardia, high blood pressure, cardio myopathy, and even sudden death (http://www.rxlist.com/adderall-drug.htm).  Thus, for physiological reasons alone, it is wise for an individual who may be considering drug therapy to also consider alternative treatment options.  The good news for drug therapy, however, is that the most severe of these side effects have occurred in very rare incidences.  For example, Canada suspended the sale of Adderall® in 2005 after 12 deaths had been associated with the drug from 1999-2003.  Of the 12 victims, five also had severe heart abnormalities (http://www.dyslexia-adults.com/t145.html).  Compared to an average of 11 million methylphenidate/amphetamine prescriptions filled per year, during this period (http://www.pbs.org/wgbh/pages/frontline/shows/medicating/drugs/stats.html), the death rate associated with stimulant drugs mirrored the death rate of the general population.  Since the incidence of these severe effects is so rare, whether or not the complications are really associated with stimulant use is somewhat ambiguous.  The neurological side effects associated with Adderall® use can be much more insidious than the more obvious cardiovascular complications.

(http://www.usdoj.gov/dea/pubs/cngrtest/ct051600.htm)

 

ADDERALL®:  NEUROLOGICAL/BEHAVIORAL SIDE EFFECTS

The neurological side effects of Adderall® include, but are not limited to, psychotic episodes, overstimulation, restlessness, irritability, insomnia, depression, headache, and motor tics (http://www.rxlist.com/adderall-drug.htm).  In many cases, an individual may experience just one of these which, on a single incidence basis, may not necessarily be severe.  For example, the prevalence of insomnia is very common in the general population; about 1 in 8 people are dealing with it at any given time (http://www.wrongdiagnosis.com/i/insomnia/prevalence.htm). Although it can be very frustrating for an individual to experience insomnia, it is by no means life threatening on an individual basis.  However, because each of these complications is somewhat common, the rate at which two or more may occur in conjunction with one another is also relatively high.  Therefore, long term exposure to these effects has been known to exacerbate negative behaviors and potentially alter an individual’s personality permanently (http://www.add-adhd-help-center.com/adderall_side_effects.htm).  These more severe complications can hurt family relationships as well as peer to peer acceptance.  Although most of these effects are not directly life threatening, they can greatly reduce the quality of life of the individual and that of his or her family members.  In the most drastic cases, suicide may seem to be the only coping mechanism for individuals.    

    

(http://hbcprotocols.com/malfunction/depression.jpg)

SCIENTIFIC EVIDENCE:  ADDERALL® AS AN EFFECTIVE MEANS OF TREATMENT

        Biederman, J. and Faraone, SV. (2002) conducted a meta analysis on the efficacy of various drug therapy treatments for ADHD.  The specific interventions that the studies were selected for included doses of Adderall® 12.5 mg. up to 30 mg. twice daily and for a 3-7 week duration.  They concluded that from six available studies, “Adderall® was efficacious for symptoms of inattention, hyperactivity, and aggression.”  Across all six studies, similar results were found as to the degree of efficacy of Adderall® on alleviating these symptoms as compared to a placebo (Faraone & Biederman, 2002).

          Biederman J. and his colleagues conducted a randomized, double-blind, placebo-controlled, parallel-group study of Adderall XR® in children with ADHD.  The purpose of the experiment was to assess the safety and efficacy of the treatment.  Each treatment group showed significant “dose-related” improvement in behavior from a recorded baseline.  A total of 509 individuals completed the study. “Both the Clinical Global Impressions Scale for improvement and Parent Global Assessment for improvement showed all doses of SLI381[(Adderall XR®)] to be superior to placebo at treatment end and both confirmed the dose-response relationship between improvement and the SLI381 dose.”  Additionally, no “spontaneously reported” adverse effects were determined to be attributed to SLI381 because of the statistical similarities between SLI381 and the placebo (Biederman, Lopez, Boellner, & Chandler, 2002).

SCIENTIFIC EVIDENCE:  ADDERALL® CARDIOVASCULAR/ BEHAVIORAL COMPLICATIONS

        A case report of a 20-year old African American college freshman showed acute myocardial infarction associated with the consumption of Adderall® and alcohol.  The individual was admitted to the emergency department after having reported two-day duration of chest pain.  It was later concluded that his consumption of Adderall® and alcohol were contributing factors to the anomaly.  There are warnings that include avoiding the consumption of Adderall® and alcohol, as well as other medications.  This is simply a case of drug misuse which, in a larger spectrum, may be the cause of life threatening complications, such as in this case (Jiao, Velez, Ringstad, Eyma, Miller, & Bleiberg, 2009)

(http://www.irishhealth.com/content/image/12712/hezr.jpg)

        Because behavioral and personality changes occur on a more individual basis and are attributed to multiple factors, scientific evidence is limited to certain case studies.  For example, a study called “An Evaluation of Stimulant Medication on the Reinforcing Effects of Play” examined five individuals and Adderall®’s effect on social interaction associated with “play.”  It was found that one of the individuals, while on the medication, “selected fewer social reinforcers than nonsocial reinforcers.”  This study concluded that Adderall® may indeed have a significant contribution to anti-social behavior.  These behaviors may, therefore, lead to other negative behaviors (LaRue, et al., 2008).

(http://www.voicesnow.org/Images/kidscircle.jpg)

        Another case study analyzed amphetamine induced psychosis in an adolescent.  A young morbidly obese female was prescribed Adderall by her physician in an attempt to help her gain better control of her school work and daily tasks.  In a follow up visit, her mother reported her being able to pay better attention as well as concrete evidence of grade improvements.  However, a week after this follow up appointment, the individual was admitted to the emergency department after having an anxiety attack.  She later reported various hallucinations and headaches, as well as “magical” thought.  She even reported thoughts of “disembowelment of her baby brother.”  Neurologically, the individual was normal.  The study discussed that the psychological effects of the amphetamines on the dopaminergic and noreadrenergic neurotransmitter systems, aside from alleviating symptoms associated with ADHD, also contributed to the individual’s psychosis.  The individual had never experienced these events before her drug therapy.  Therefore, the young female’s use of Adderall® can be seen to have had an effect on her psychosis (Surles, May, & Garry, 2002)

(http://www.ubergizmo.com/photos/2007/5/virtual-hallucination.jpg)

  CONCLUSION

        Due to the many recent advancements in medicine and psychology, psychologists and physicians alike are more able to properly diagnose an individual with ADHD.  Additionally, they are able to pinpoint the symptoms and severity of ADHD in each unique case.  With the overall better understanding of the disorder and its treatments, researchers are able to evaluate the efficacy of these treatments and determine if there are any negative side effects associated with them.

        As we have seen, stimulant treatment of ADHD, specifically Adderall®, offers a highly effective means of treating the disorder as claimed by the many pro-Adderall® web pages and studies available.  However, stimulant treatment acts as a double-edged sword in that, along with its many benefits come the potential for harmful side effects.  By law, the Adderall® brand is required to list potential side effects associated with their product.  However, they are not responsible to go into lengthy discussion of these side effects.  The aid of concerned scientists and the general public helps to illuminate some of the lesser understood side effects, as well as highlight those that are of the greatest concern. 

        The most popular concerns of Adderall®’s side effects were the potential cardiovascular and neurological/behavioral side effects.  The various studies discussed provide some supporting evidence for the linkage of Adderall® with these side effects.  Additionally, these studies discuss that much is still unknown about the strength of this linkage.  Therefore, all statements and research must be taken with all other things considered.  ADHD, although very common in the general population, is very unique from case to case.  This makes it difficult to determine exactly who will be affected by what treatment, and how effective each treatment will be.  The most general conclusion is that Adderall® has certainly been shown to effectively reduce the symptoms of ADHD.  Additionally, there is much concern for, and evidence of, complications that have been associated with Adderall®.  Those who may be considering it as a treatment should be well aware of these possible side effects, and should seek as much information as possible before making the decision to use it or not to use it.

Works Cited

A, S., M, D.-W., F, R., A, R., & J, H. (2006, January). [Genetic background of ADHD: population studies, genes of the catecholamine system]. Retrieved October 5, 2009, from NCBI Pub Med: http://www.ncbi.nlm.nih.gov/pubmed/16756025

Adderall. (n.d.). Retrieved October 5, 2009, from Rx List: The Internet Drug Index: http://www.rxlist.com/adderall-drug.htm

Adderall. (n.d.). Retrieved October 5, 2009, from Drug News: http://www.adderall.net/

Adderall Side Effects. (n.d.). Retrieved October 5, 2009, from Attention Deficit Disorder Help Center.: http://www.add-adhd-help-center.com/adderall_side_effects.htm

Attention-Deficit / Hyperactivity Disorder (ADHD). (n.d.). Retrieved October 5, 2009, from Centers of Disease Control and Prevention: http://www.cdc.gov/ncbddd/adhd/data.html

Biederman, J., Lopez, F., Boellner, S., & Chandler, M. (2002). A randomized, double-blind, placebo-controlled, parallel-group study of SLI381 (Adderall XR) in children with attention-deficit/hyperactivity disorder. Pediatrics , 258-266.

Collier, M. (2008, December 8). Adderall: History, Uses, Side Effects, and Withdrawal. Retrieved October 5, 2009, from Associated Content: Health and Wellness: http://www.associatedcontent.com/article/1268435/adderall_history_uses_side_effects.html?cat=70

Faraone, S., & Biederman, J. (2002). Efficacy of Adderall® for Attention-Deficit/Hyperactivity Disorder: A meta-analysis. Journal of Attention Disorders , 69-75.

Jiao, X. M., Velez, S. M., Ringstad, J. M., Eyma, V. M., Miller, D. M., & Bleiberg, M. M. (2009). Myocardial Infarction Associated with Adderall XR and Alcohol Use in a Young Man. The Journal of the American Board of Family Medicine , 197-201.

LaRue, R. H., Northup, J., Baumeister, A. A., Hawkins, M. F., Seale, L., Williams, T., et al. (2008). An Evaluation of Stimulant Medication on the Reinforcing Effects of Play. Journal of Applied Behavioral Analysis , 141-143.

Methamphetamine Effects. (n.d.). Retrieved October 5, 2009, from Recovery Connection: http://www.recoveryconnection.org/drug_index/methamphetamine.php

Stress: The Fight or Flight Response. (n.d.). Retrieved October 5, 2009, from Psychologist World: http://www.psychologistworld.com/stress/fightflight.php

Surles, L. K., May, H. J., & Garry, J. P. (2002). Adderall-Induced Psychosis in an Adolescent. The Journal of the American Board of Family Practice , 498-500.

Tomlinson, H. (2005). Retraining a Dyslexic Brain. Retrieved October 5, 2009, from Dyslexia Adults Link: http://www.dyslexia-adults.com/t145.html

Woodworth, T. (2000, May 16). DEA Congressional Testimony. Retrieved October 5, 2009, from Drug Enforcement Agency: http://www.usdoj.gov/dea/pubs/cngrtest/ct051600.htm

 

 

 

VUlogo

Psychology Department

The Health Psychology Home Page is produced and maintained by David Schlundt, PhD.
  

me

VuLogoVanderbilt Homepage

Return to the Health Psychology Home Page
Send E-mail comments or questions to Dr. Schlundt