Longterm affects of amphetamines?

July 22, 2008 8:07 AM

What are the potential longterm effects of regular amphetamine (i.e., adderall, ritalin) use? Does anyone really know?

As more and more of my friends have begun daily regimens of amphetamines, I've begun wondering how much is known about the longterm effects of these drugs. It's not unreasonable to suspect that running any bodily organ on overdrive for years on end might have some negative consequences, but I haven't seen much research on the subject. This psychiatrist's blog post, however, suggests the suspicion could be well-founded.

Does anyone have any information -- anecdotes are fine, but research would be better -- that says one way or another whether amphetamine usage over the long run is anything to worry about?

posted by decoherence to health (18 comments total)

My anecdotable evidence is that I've been taking Adderall XR for about 3 years with no noticeable consequences. I take 40mg each weekday and skip the weekends.
posted by demon666 at 8:31 AM on July 22

I have a hard time believing that this post is not a joke or a troll.

NIDA/NIH pages on methamphetamine abuse. The reported problems occur with all amphetamines.
posted by ikkyu2 at 9:10 AM on July 22

Amphetamine psychosis.
posted by tallus at 9:11 AM on July 22

This fits squarely in the anecdote category, and there's no way I can prove it, but I think adderall made me fat. I was thin before I started taking it (at age 17), I was dangerously thin for the four years I was on it (often forgetting to eat, no appetite), and when I stopped taking it, I immediately gained about sixty pounds. Forty of those pounds are still hanging around eight years later. I eat less than 1600 healthy calories a day (lots of lean protein and fibre - I've kept track for weeks at a time, and the calorie count is consistent), I rarely eat sugar, I never snack on anything but the odd apple, I walk three miles up and down steep hills to and from work every day, I do pretty strenuous hikes nearly every weekend, and the weight just doesn't move. It seems pretty apparent to me that my metabolism was permanently damaged by the amphetamines. Maybe not directly- maybe it was the four years of malnutrition caused by the amphetamines making me lose all interest in food, but the result is the same.
posted by F.Jasmine Addams at 9:15 AM on July 22

I have a hard time believing that this post is not a joke or a troll.

Giving the poster the benefit of the doubt, I think he's asking about the long-term health consequences of medically supervised treatment with prescription medication for ADD/ADHD, not rampant speed binges, but I could be wrong.
posted by infinitywaltz at 9:19 AM on July 22

Read up on Adderall (all of 'em really, but I believe Adderall sparked the initial concern) and cardiac issues: you can start with the FDA advisory committee notes, but I think there's probably more out there.
posted by BundleOfHers at 9:20 AM on July 22

Not a joke, not trolling. Maybe I should've been more specific in my phrasing of the question. I'm not asking about recreational amphetamine use and/or abuse; I'm well aware of addictive potential and the possibilities for abuse. Rather, I'm asking about whether therapeutic, doctor-prescribed, longterm use of amphetamines (usually for ADD/ADHD treatment) at non-excessive levels might have deleterious effects on brain functioning down the road. Does taking Adderall daily for years in order to concentrate better present any risk to the individual, even assuming that dosage levels remain within normal therapeutic limits? Is there good research on this question?
posted by decoherence at 9:27 AM on July 22

I can add another anecdote. I've been taking Ritalin daily for about 6 years, but not for ADHD. I have narcolepsy, and the stimulants help to keep me awake during the day. I had some slight appetite suppression at the beginning, but that all seemed to even out after a few weeks. Other than that, I haven't really experienced any side effects. My blood pressure remains below normal like it has always been, and my heart rate is normal as well.

I think most of the issues with these drugs are with improper usage, or when an inappropriate dosage is prescribed.

I'm not sure what other consequences there are of long term use, but in my case they have to be better than the consequences of frequently dozing off while driving on the freeway...
posted by thejanna at 9:29 AM on July 22

F. Jasmine Addams: Your anecdote is unusual. It's far more common for people to lose weight when starting taking Adderall because one of the side effects is decreased appetite. I know that happened to me (but then I didn't make any attempt to resist this because I needed to lose the weight anyway.)


With regards to controlled legal use of amphetamines like Adderall, I could speak from personal experience, but just another anecdote is probably not all that useful here. From what my psychiatrists have told me, there are often problems with addiction, decreased effectiveness, and loss of appetite, and this holds up with what I've read. My current psychiatrist is watching out for decreased tolerance of exercise, but that's a new one to me. I'm not claiming anything about any of the other problems mentioned here, but I'm willing to bet that none of my psychiatrists are going to exaggerate potential negatives (considering they are financially dependent on me continuing to see them). So if one of your friends already eats very meagerly or has a history of abusing addictive substances, then it might be something to worry about. I make no claim about whether you should worry about other problems.
posted by ErWenn at 9:38 AM on July 22

As more and more of my friends have begun daily regimens of amphetamines...

I'm asking about whether therapeutic, doctor-prescribed, longterm use of amphetamines...

Wow, your friends' doctors are probably quacks, for the most part. If there are "more and more" of your friends are on this stuff, it seems unlikely to me that they all need it. I would be much more concerned about the negative effects these meds can have on someone who might be misdiagnosed.
posted by sunshinesky at 9:55 AM on July 22

addiction, decreased effectiveness, and loss of appetite

Decreased effectiveness and loss of appetite aren't really what I would think of long-term health problems. Amphetamines, like a lot of medications, will create a tolerance over time. That's why you see such a variable in dosages (5mg - 40mg +). Loss of appetite, while a problem in some patients, is probably an overwhelming positive.

But no, as long as you aren't taking 3-4 week meth binges, amphetamines are fairly well tolerated. In fact a lot of the negative material about amphetamine abuse doesn't necessarily stem from the amphetamine use directly, but from the poor nutrition, care and stress of staying up days at a time. In fact, meth is actually prescribed in some severe cases of ADD/ADHD (though in truth, a very well informed friend of mine said that such cases are extremely rare and usually when someone has a lot of other things "going on" that would necessitate it).

That said I would not be surprised if heart problems increased for long-term use for those who were genetically predisposed to heart conditions. Those are exceedingly hard to prove. Amphetamines have been with us for more than half a century, anything blatantly bad would pop up (e.g., heart failure across the board, at an early age, say 50s).

Not that amphetamines are candy, but on the list of things I'd would be willing to do daily, it would be above cigarettes and alcohol.
posted by geoff. at 9:55 AM on July 22

Buh I should say, "Pack a day versus a six pack a day vs 20 mg of generic amphetamines" ... well I'd chose the latter. I'd be surprised in any sort of "gun to the head and you must chose" scenario, that a doctor would not advise the last option.
posted by geoff. at 9:58 AM on July 22

sunshinesky: Most of them don't need it. They're generally overachievers who are in grad school or who are beginning their professional lives. They're taking it to do marginally better in school and at work. And the drugs do work as advertised -- they're able to concentrate better, and for longer periods of time. I don't think this is especially uncommon either, as there has recently been a spate of articles in the popular press touting the growing number of students and young professionals regularly taking Ritalin, Adderall, etc. for performance-enhancement purposes.

My concern -- and it's just a hunch -- is that nothing comes without a cost; it shouldn't be possible to jack your brainpower up 10% for years on end without seeing some negative returns down the road. I really have no idea whether this is founded though, which is why I'm curious to see if anyone else knows the answer.
posted by decoherence at 10:05 AM on July 22

of course it is not unfounded, decoherence. The belief that one can take amphetamines long-term with no side effects even at "therapeutic" doses is ridiculous. Those side effects may be less bad than whatever condition the amphetamines are treating. I mean, virtually any medication has side effects. Chemotherapy is basically poison that, we hope, is slightly more poisonous to the cancer than to you. But to believe that one can take methamphetamine or dextroamphetamine or whatever for years with no effects is wishful thinking.

How quickly these effects occur and at what dosages is controversial. Obviously people don't want to believe they are screwing with little Timmy's heart by putting him on adderall for years, so it's tough to get good data here. I don't think there have been any really good meta studies of people who use amphetamines at medical doses for years on end.

But there ain't no such thing as a free lunch. And amphetamines are strong, strong medication.
posted by Justinian at 11:47 AM on July 22

Note that I have no problem with people taking Adderall; I wish it was available over the counter. I'm just saying it's not wise to pretend that taking it for years and years is not a big deal with few effects.

But the key point I'm making is that, no, I don't believe there is good data about this one way or another. We know that people taking amphetamines at medical doses for short periods of time don't generally show long term effects. We know that people taking amphetamines at "abusive" doses for short periods of time don't generally show long term effects. We know that people taking amphetamines at abusive doses for long periods of time DO show long term effects.

What we don't know all that well is if people taking amphetamines at medical doses for long periods of time show long term effects. And that's what you're asking, unfortunately. But I don't think it's exactly a fringe opinion to believe that there are probably some effects.
posted by Justinian at 11:51 AM on July 22

I just read an article called "Speed Dieting" in the current issue of Allure magazine that states in one paragraph:

"Adderall is more famously related to crystal meth--both are in the amphetamine family, though with different molecular structures," says Thompson, who has mapped the effects of methamphetamine on the brain. Where meth can cause brain damage, "Adderall would have to be taken in a very high dose to kill brain cells. Note that the daily dose of Adderall is available in 5, 10, 15, 20 or 30 milligrams, and our meth addicts, who lost 1 percent of their brain tissue per year, were taking about 100 times that, or around 3,000 milligrams a day. Of course, people who are taking Adderall for weight loss are probably taking it in higher dosages than they need, which increases the likelihood of addiction."

"When taken in a higher than prescribed dosage, Adderall can be psychologically and physically addictive, and some long-term users need to take increasing amounts to get the same appetite suppression," says Thomspon. And then there was the incidence of sudden death. In 2005, Health Canada (the equivalent of our Food and Drug Administration) suspended the sale of Adderall XR after a manufacturer's review submitted to the agency found 20 sudden and heart-related deaths and strokes in adults and children taking prescribed doses since the introduction of Adderall in 1994.

This article section is typed verbatim from pages 204 to 205 of the August 2008 issue of Allure with Victoria Beckham on the cover.

So, from this medical research and my own anecdotal experience (my mother took diet pills for years, developed high blood pressure, had to stop, became morbidly obese, and has been told by her doctor she will most likely die within a year due to heart disease... she is 56; I took diet pills briefly in my 20's, developed insane mood swings, extreme insomnia in the range of sleeping 1-2 hours a night on 3 or 4 sleeping pills, which resulted in me ripping a door out of the frame in my home and being remanded to psychiatric care for one year and antidepressants)... well, yeah, if you have ADHD or ADD, take the recommended dosage.

If you're taking it to lose weight, you have a high chance of becoming tolerant, dependent, turning into Judy Garland (1 to wake up! 1 to sleep! pill rotation), and then becoming overweight by blowing out your adrenal system and having difficulty ever regaining your figure that you had on Adderall or Ritalin or what-have-you.

You may not lose the brain tissue mass, but the rest of the story is not pretty. Take it if you need it and your doctor prescribes it. Otherwise, YMMV.

Oh, and as far as going from feeling super-focused and smart to whatever else? My mother also graduated high school a year early and now has pretty serious trouble completing a coherent thought without help. She exhibits many signs of amphetamine-based brain damage. My ex-husband (who smoked ice for over a year) and she are about on par as far as being incoherent and delusional goes... what took him two years, took her 35.

Same destination, different paths, different dosages. You can decide from there. When you take drugs you don't need because you don't have the self-discipline to eat right, work out, or turn the TV/Blackberry/Cell phone off and drink a cup of coffee... you do the math. As others said, no shortcuts are free.
posted by Unicorn on the cob at 9:15 PM on July 22

I'm asking about whether therapeutic, doctor-prescribed, longterm use of amphetamines at non-excessive levels might have deleterious effects on brain functioning down the road.

That is a hard question. The clinical trials for safety and efficacy in these drugs lasted less than a year, for obvious reasons - you can't delay a drug to market by 10 years while you follow a cohort of people who keep taking it, it's nearly impossible to do that trial.

So we're stuck with post-marketing safety data, which really isn't very good for a variety of reasons.

In my day job as a neurologist I find myself frequently taking people off amphetamines and amphetamine-like compounds. High blood pressure, cardiac arrhythmias, kidney failure are some of the things I've seen; more frequently I see sleep disruption and its attendant cognitive decline; mood and anxiety side effects; 'spells' that turn out to be psychiatric episodes of panic or agitation; psychosis; and funny little neurologic things like dyskinesias, myoclonus or tics. In most of these cases the abnormalities go away when the drug is discontinued.

I always feel like I'm out of the mainstream when I take someone off these compounds. After all, one of my colleagues prescribed them. That suggests to me that those same colleagues are probably giving them to lots of other patients whom I never see, and those folks presumably are deriving some benefit from them. As for myself I only use Ritalin in patients for short periods of time, 6 to 12 weeks, usually to help with a severe, sudden or situational depression of mood. Sometimes I wonder if this means I am out of date in my prescribing patterns. But unlike some of the patients who take these drugs, I don't let it keep me up at night.
posted by ikkyu2 at 11:09 PM on July 22

Dextroamphetamine has been prescribed since the 1930s, and methylphenidate (Ritalin) since the 1960s. I imagine if there were any obvious and significant adverse effects from continued use at therapeutic doses, they'd have been noticed by now. I agree with others, though, that there probably are more subtle effects over the long haul. You can poke around pubmed to see if there have been any studies or reviews.

Anyway, here's some more anecdata for you. I work with meth addicts at a research facility, and many of them have been using daily for decades. I'm sure there's got to be some quantifiable brain damage on the whole, and, granted, our population is fairly self-selected, but by and large they seem pretty normal. If they're stunted intellectually/emotionally, it's hard to tell what's due to the drug, to the lifestyle, to fucked-up childhoods, etc. Most are even surprisingly physically healthy - haggard appearance, dental problems, and hygiene issues aside. And these people have generally abused multiple substances besides meth (usually alcohol, cocaine, marijuana, and of course nicotine), never go to the doctor, eat like shit or don't eat at all, stay up for days at a time, and regularly snort/smoke/inject stuff cooked up in some stranger's bathtub and diluted with with god knows what. The 3 gram figure quoted above by Unicorn on the cob is actually an INSANE amount of meth - I've only met one guy who ever did that much, and he only did it a couple times, and he was enormous - but they still use in far greater quantities than your friends do. Even a gram per day is like 50 times a typical ADHD prescription, and meth is more potent than Adderall anyway.

So, again, I'm sure there are long-term side effects, and certainly some people are more vulnerable to them than others, but the human body is a resilient, amazing thing.
posted by granted at 1:16 AM on July 23