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24 things to consider before taking Adderall

Both legal and illegal usage rates of prescription stimulants continue to remain stable or rise for everyone from young children to adults

That's why it's probably no surprise that by most measures, both legal and illegal usage rates of prescription stimulants like Adderall, Ritalin, Concerta, and Vyvanse (or the generic forms of some of these drugs) continue to remain stable or rise for everyone from young children to adults in the workplace and even among the elderly.

For people with ADHD, these drugs can be lifesavers. But as we know, many others are tempted by potentially cognitive enhancing drugs too, even if there are big questions about whether or not they work. We don't get enough sleep and everyone from students to office workers is trying to get an extra boost.

But before you jump on the bandwagon, here are some facts about Adderall and other stimulants you should know.

First of all, you should (and legally have to) talk to your doctor before getting Adderall.

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Adderall, Ritalin, and similar medications are Schedule II drugs, which have medical uses but also have a high potential for abuse that can potentially lead to dependence — they should only be taken after a consultation with a doctor.

They are generally prescribed to treat attention-deficit hyperactivity disorder. The way your body responds to the drug may depend on whether you actually have ADHD, according to some research.

However, there isn't a simple test that determines whether a person definitely has ADHD.

To make that diagnosis, your doctor or mental health provider may ask questions to see whether you have a certain number of the 18 ADHD symptoms listed in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-5) — they check for six symptoms in people 16 and younger and five symptoms of inattention or hyperactivity for anyone older. A doctor who decides that those symptoms aren't caused by something else may prescribe a stimulant to see whether that helps.

If you like the feeling of Adderall or Ritalin, you may be less likely to have ADHD.

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A 2014 study had the surprising finding that people who were genetically predisposed to feel euphoria when on stimulants were also less likely to have genes that predisposed them to ADHD and schizophrenia.

This might explain why some people who don't have ADHD may be especially likely to abuse stimulants — it makes them feel particularly good. Still, that's probably not the prime factor that drives abuse. A recent study found that the best predictor of stimulant misuse among adolescents was the use of other mind-altering drugs like alcohol, tobacco, or marijuana, which the researchers say indicates there's a strong social component.

More and more adults are getting prescriptions for ADHD medication.

Between 2007 and 2012, the number of adults with ADHD prescriptions roughly tripled.

In 2007, there were 5.6 million monthly ADHD prescriptions for people aged 20 to 39. By 2012, that number approached 16 million.

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The number of adults who have an ADHD prescription is now rising faster than the number of new prescriptions for children getting the same drugs.

Some reports indicate that despite any concerns about overuse of stimulants, there was a 5.9% increase in prescribed stimulant use from 2014 to 2015 and another 4.2% increase in utilization in 2016. Trends of increased utilization are expected to continue.

Stimulants might provide some cognitive enhancement in people with adult ADHD.

Other research shows that stimulants don't necessarily provide cognitive enhancement in kids.

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If you are creative, stimulants could impair your abilities.

In one study, researchers had a small group of young adults perform a series of tasks related to creativity to see the kind of impact Adderall might have.

Adderall didn't affect performance on all tasks, but on the tests in which it did have an effect it seemed to help those who were low-performing.

However, people who had performed well on the test without taking stimulants showed either no change or did worse while taking Adderall.

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ADHD drugs can be addictive.

Stimulant-related emergency-room visits have risen significantly in recent years.

Stimulants like Adderall elevate blood pressure and speed up your heart.

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Stimulants can cause circulatory problems and constrict blood vessels, leading to increased blood pressure.

This can increase the risk for a heart attack or a stroke, and you should contact a doctor if you experience chest pain, shortness of breath, or fainting after taking Adderall.

Drinking while taking Adderall may be even more dangerous.

Adderall and other stimulants may increase anxiety.

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By increasing heart rate and enhancing the effects of neurotransmitters like dopamine, stimulants can significantly increase anxiety.

This can cause shortness of breath, dry mouth, nervousness, paranoia, and other side effects.

Stimulants can improve memorization skills ...

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... and there's some evidence that they can boost working memory, but only very slightly.

A review of different studies on the cognitive benefits or harms of stimulants found limited effects on working memory, the ability to hold and manipulate different pieces of information simultaneously.

That's not very significant for most people but may provide "a small advantage" in certain situations, which may explain the draw for people who might benefit from a small boost, like eSports players.

Another review found that people who performed poorly on tests to begin with saw the most improved performance, leading researchers to think that stimulants may be better at correcting deficits than at enhancing cognitive abilities.

The placebo effect may account for some of the perceived cognitive benefits of stimulants.

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Some research shows that people who think they are going to be given a drug like Ritalin or Concerta don't show cognitive improvement but do pay better attention and act more engaged.

In a recent study, college students were given either a placebo pill that they thought was Ritalin or no pill before taking a series of cognitive tests.

When they thought they had taken Ritalin, students said they were more alert and able to focus on the work.

Scary side effects include heart attacks and sudden death.

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the sudden-death cases, which are rare,

Every major ADHD drug has been cited by the FDA for false and misleading advertising.

According to The New York Times, the FDA has "cited every major ADHD drug — stimulants like Adderall, Concerta, Focalin, and Vyvanse, and nonstimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times."

That story quotes experts who argue that marketing — and, in some cases, false marketing — by pharmaceutical companies is behind much of the rise in the number of people taking Adderall, Vyvanse, Concerta, and Focalin.

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They note that sales of stimulants have quintupled since 2002 and point to potentially misleading quizzes that let adults test whether they have ADHD. The Times polled more than 1,100 adults and found that more than half scored in a range that said they "possibly" or "likely" suffer from ADHD, suggesting the criteria are far too inclusive.

In rare cases, stimulant abuse has led to mental illness and psychosis.

The FDA's medication guide to Adderall warns people to call doctors immediately if they experience mental problems, "especially seeing or hearing things that are not real, believing things that are not real, or are suspicious."

Worsened mental illness for adults and psychotic symptoms for children are among the listed side effects.

The medical literature includes case reports of methylphenidate, the active ingredient in Ritalin and Concerta, triggering depression in a 7-year-old and terrifying hallucinations in a 15-year-old. And The New York Times reported on the highly unusual but tragic case of Richard Fee, a 24-year-old from Virginia Beach. Fee developed very serious mental-health problems while battling a severe addiction to prescription stimulants and ultimately took his own life.

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Almost 20% of high school boys have received a diagnosis of ADHD, and more kids are prescribed stimulants than ever before.

A 2013 CDC report showed that the number of kids ages 4 to 17 who received a diagnosis of ADHD rose 41% over the past decade. About two-thirds of kids with a diagnosis are prescribed stimulants like Adderall and Ritalin.

Boys receive ADHD diagnoses at more than twice the rate of girls and are also more likely to receive prescription stimulants. Almost 20% of high school boys have received an ADHD diagnosis.

Some people argue that this reflects better recognition and diagnosis of ADHD, but others say that it's a dangerous overuse of medicine to calm kids down and help them out in school. A big 2014 feature in Esquire

Many people who use Adderall without a prescription don't think they are taking a drug.

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Up to one-third of college students use stimulants — and they don't think it's cheating.

While it's hard to estimate illegal or off-label usage of prescription stimulants, one 2014 study showed that almost 20% of Ivy League students used an unprescribed study aid at least once while in college — though those "at least once" rates may not be the best way to measure regular off-label use, which is harder to assess.

Overall, estimates of the percentage of college students who have illegally taken stimulants range from 6.9% to 35.6%.

Of the Ivy League students surveyed, 33% did not view using stimulants as cheating, though 41% did. The remaining 25% were unsure.

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Because students don't consider Adderall use a big deal, they talk about it freely on social media — giving researchers plenty of data to analyze.

People aren't scared to mention on Twitter that they are using Adderall, and though there are questions about how reliable behavioral information gathered from Twitter is, data scientists are taking note.

Computer science researchers at Brigham Young University analyzed tweets that mentioned "Adderall" between November 2011 and May 2012. There were an average of 930 Adderall-related tweets a day, but that number rose to 2,813 on Dec. 13 and 2,207 on April 30 — a spike the researchers attributed to finals cramming.

And geotagging revealed where people were tweeting about Adderall most: The largest clusters of tweets about Adderall per 100,000 students were near universities in the Northeast and South, a finding that matches previous research

Doctors have ignored FDA warnings about prescription stimulants.

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Pro baseball players take ADHD meds at rates that are much higher than normal.

After Major League Baseball announced a stimulant ban, at about the same time regulators were cracking down on steroid abuse, the number of pro baseball players who requested therapeutic exemptions that would allow them to continue to take stimulants jumped from 28 players to 103, or 8% of the league. The number is now even higher: In 2013, 119 requested those exemptions.

Those rates are more than double the 4% of adults who the National Institute of Mental Health says are affected by ADHD. Some say that professional athletes are more likely to have ADHD than the rest of the population, but not everyone agrees.

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"This is incredible. This is quite spectacular," said Dr. Gary Wadler of the World Anti-Doping Agency, when the MLB ban led to a jump in therapeutic exemptions. "There seems to be an epidemic of ADD in major league baseball."

Part of the reason the "cognitive enhancing" effects of stimulants like Adderall are unclear is that we don't have very good tests for them.

Some researchers caution that the reason it's so hard to say whether these drugs improve cognitive performance is that most of our tests are designed to find impairment, not improvement, in healthy people.

As researchers

Better tests would tell us far more.

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