ADHD Drugs: Hallucinations Not Uncommon

FDA Examines Incidence of Psychotic Symptoms in Children Taking ADHD Medications

By Salynn Boyles WebMD Health News Reviewed by Louise Chang, MD

Jan. 26, 2009 — Treatment-related hallucinations and other psychotic symptoms in children with attention deficit hyperactivity disorder (ADHD) may be more common than previously thought, FDA officials report in the latest issue of the journal Pediatrics.

In an earlier investigation, FDA researchers identified more than 850 separate incidences of hallucinations and other psychotic episodes among children taking stimulants used to treat ADHD.

The investigation prompted federal officials to require new labeling on the drugs, including Ritalin LA, Concerta, Adderall XR, Focalin, Focalin XR, Metadate CD, Daytrana, and Strattera, warning of possible psychiatric side effects.

An estimated 2.5 million children and teens take these and other stimulant-based medications to treat ADHD symptoms.

Nearly half of the cases of hallucination and other psychiatric side effects reviewed by FDA researchers involved children younger than age 11.

And in more than nine out of 10 cases, the children had no reported history of psychiatric events.

Bugs, Worms, and Snakes

Hallucinations involving insects, snakes, or worms were among the most commonly reported psychiatric events among children and teens, FDA medical epidemiologist and drug safety expert Kate Gelperin, MD, MPH, tells WebMD.

“Some children described feeling a sensation of bugs or worms crawling on their skin,” she says.

One case detailed in the report involved a 12-year-old boy with cerebral palsy who said he saw roaches surrounding him two hours after taking an ADHD drug containing methylphenidate. The hallucination lasted several hours, recurred when the boy took an additional dose of the drug, but stopped altogether when the drug was discontinued.

An analysis of 49 randomized clinical trials found that for every 100 children who take ADHD drugs for a year, between one and two experience a drug-related psychotic event.

But in the Pediatrics report, the FDA researchers conclude that this estimate is probably low, in part because the clinical trials often excluded children with a history of adverse reactions to ADHD drugs.

“Patients and physicians should be aware of the possibility that psychiatric symptoms consistent with psychosis or mania, when they arise in the course of drug treatment of ADHD, may represent adverse drug reactions,” the FDA researchers write.

Cardiovascular Concerns

ADHD researcher William Pelham Jr., PhD, tells WebMD that hallucinations and similar psychiatric symptoms are well known to clinicians who specialize in treating children with the disorder.

Pelham is a professor of psychology, pediatrics, and psychiatry at the State University of New York at Buffalo.

“Off the top of my head, I would say I have seen this in about one out of every 100 kids I’ve treated,” he says.

But he adds that pediatricians and other clinicians who don’t specialize in treating ADHD may fail to associate psychotic episodes with stimulant drug use.

He notes that the drugs have also been linked to sudden death in children with heart problems. It is now recommended that children be evaluated for heart problems before beginning treatment with ADHD medications.

“The hope is that reports like this one will raise awareness that these are not benign medications. They are psychoactive drugs with side effects,” he says.

Warnings Included on Labels

A spokesman for Shire Pharmaceuticals, which markets extended-release Adderall XR, tells WebMD that there is little new information in the published FDA report and that the drug’s labeling now includes a warning about possible psychiatric side effects, including hallucination.

“Stimulant medications are proven, safe treatments for people with ADHD,” says Shire Director of Corporate Communications Matt Cabrey. “But with any medication there is a risk for adverse events, and these drugs are no exception.”

Eli Lilly and Co. spokesman David Shaffer also noted that the labeling for Strattera was altered to warn of possible psychiatric side effects after the FDA first made its concerns public.

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“David F. Velkoff, M.D., our Medical Director and co-founder, supervises all evaluation procedures and treatment programs. He is recognized as a physician pioneer in using biofeedback, qEEG brain mapping, neurofeedback, and neuromodulation in the treatment of ADHD, Autism Spectrum Disorders, and stress related illnesses including anxiety, depression, insomnia, and high blood pressure. Dr. David Velkoff earned his Master’s degree in Psychology from the California State University at Los Angeles in 1975, and his Doctor of Medicine degree from Emory University School of Medicine in Atlanta in 1976. This was followed by Dr. Velkoff completing his internship in Obstetrics and Gynecology with an elective in Neurology at the University of California Medical Center in Irvine. He then shifted his specialty to Behavioral Medicine and received his initial training in biofeedback/neurofeedback in Behavioral Medicine from the leading doctors in the world in biofeedback at the renown Menninger Clinic in Topeka, Kansas. In 1980, he co-founded the Drake Institute of Behavioral Medicine. Seeking to better understand the link between illness and the mind, Dr. Velkoff served as the clinical director of an international research study on psychoneuroimmunology with the UCLA School of Medicine, Department of Microbiology and Immunology, and the Pasteur Institute in Paris. This was a follow-up study to an earlier clinical collaborative effort with UCLA School of Medicine demonstrating how the Drake Institute's stress treatment resulted in improved immune functioning of natural killer cell activity. Dr. Velkoff served as one of the founding associate editors of the scientific publication, Journal of Neurotherapy. He has been an invited guest lecturer at Los Angeles Children's Hospital, UCLA, Cedars Sinai Medical Center-Thalians Mental Health Center, St. John's Hospital in Santa Monica, California, and CHADD. He has been a medical consultant in Behavioral Medicine to CNN, National Geographic Channel, Discovery Channel, Univision, and PBS.”

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