The national Adderall shortage that began in the fall of 2022 has brought renewed attention to the embattled drug, which is used to treat attention deficit hyperactivity disorder and narcolepsy.
Adderall became a go-to medication for ADHD over the past two decades, but quickly came under fire due to overprescribing and misuse. In some cases, people who do not have a proper diagnosis of ADHD are using the drug for its perceived cognitive-enhancing effects, leading to an increase in their rates of drug abuse and dependence.
Misuse of Adderall has not only led to its stigmatization as a drug of abuse, but can also cause negative physical side effects, including cardiovascular complications, sleep disturbances, and addiction.
I am a neuroscientist specializing in studying the dopamine system in both the brain and the peripheral immune system. My research specifically examines the short- and long-term effects of psychostimulant drugs like methamphetamine on a protein that transports dopamine, a chemical messenger that is not properly regulated in people with ADHD.
Through this work, I aim to better understand the complex interaction between drug use and the dopamine system, which may ultimately lead to new treatments for drug addiction and related disorders. Unfortunately, I have seen that the stigma and false narratives surrounding Adderall have made it more difficult for patients who need this medication to access it.
How Adderall Treats ADHD
Adderall is the brand name for a mixture of some types of amphetamines, which are stimulants that increase dopamine levels in the brain to help address deficits in people with ADHD.
The underlying processes that lead to ADHD are not well understood. The main symptoms include hyperactivity, inattention, mood swings, temper, disorganization, sensitivity to stress and impulsivity.
Multiple studies suggest that these symptoms may be due to inadequate regulation of dopamine levels in the brain.
Neurons have a protein called a dopamine transporter that normally works like a vacuum cleaner, sucking the chemical into the neuron. But people with ADHD have a leaky dopamine transporter, meaning that dopamine leaks out of the neuron into the surrounding environment of the synapse, the space between neurons where chemical messages are passed back and forth.
Adderall is thought to work by blocking this leaky protein, preventing dopamine from leaving the neuron via the dopamine transporter. This is believed to stabilize dopamine levels in the brains of ADHD patients, thereby reducing their debilitating symptoms.
The paradoxical effects of Adderall
People who do not have ADHD usually have a functioning dopamine transporter that is capable of maintaining balanced levels of this chemical inside and outside the neuron. However, when they use amphetamines like Adderall, the drug can disrupt the transporter’s ability to remove dopamine from the synapse, as well as cause it to work backwards and expel dopamine out of the neuron. This results in too much dopamine in the synapse, which can lead to feelings of euphoria and increased wakefulness.
While these effects may seem good on the surface, misuse of the medication is problematic because it can lead to cardiovascular problems. Current evidence suggests that Adderall does not significantly increase the risk of cardiovascular disease in people with ADHD. But people without ADHD who abuse Adderall can become dependent on the drug and take it in dangerous doses.
Adderall misuse does not just involve a harmful cycle that reinforces its use due to its rewarding effects. It also reinforces dependence by causing negative emotional states that some researchers have called the “dark side” of addiction. Excessive activation of the brain’s reward system disrupts its normal functioning, resulting in a decrease in overall sensitivity to reward signals. It also leads to a persistent activation of the brain’s stress systems, resulting in feelings of anxiety and restlessness in the absence of the drug.
Adderall works when you need it
Other medications such as methylphenidate, known by the brand name Ritalin, also treat ADHD by targeting the dopamine transporter.
While Adderall and Ritalin reduce symptoms of hyperactivity, impulsivity, and inattention in people with ADHD by stabilizing dopamine levels, they do so using different mechanisms. Ritalin reduces dopamine transporter leakage by directly blocking entry. Adderall also reduces leakage, but by competing with dopamine for entry into the transporter.
In people without ADHD, both Ritalin and Adderall significantly increase brain dopamine and induce euphoria, hyperactivity, and other symptoms. However, both drugs are equally beneficial for ADHD patients.
To treat anxiety, depression, narcolepsy, and other neuropsychiatric diseases, millions of patients around the world take medications that target the transport of dopamine and other neurotransmitters such as norepinephrine and serotonin, but their use is not stigmatized by recreational abuse.
Due to the euphoria-inducing properties and hyperactivity that Adderall can induce in those who do not need the drug, its misuse and abuse have unfortunately promoted false narratives about Adderall among those who do need it. However, for patients with ADHD, it can reduce negative symptoms and greatly improve quality of life.
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