Written by Hannah Harp
Spoon Feed
There is no causal relationship between stimulant use and psychotic experiences for children.
Am I taking crazy pills?
Psychotic experiences like delusions and subclinical hallucinations have been reported as a side effect of stimulant use in pediatric patients. While clinical trial data does not bear out that relationship, other observational studies have noted significantly higher rates of psychotic experiences in patients taking stimulant medication for ADHD. In 2006, the FDA even issued an alert urging closer monitoring for subclinical psychotic symptoms in patients on stimulants. Meanwhile, other studies have shown high prevalence of psychotic experiences in patients with ADHD, medicated or not.
This paper asks, are stimulants provoking psychotic symptoms, or are patients prone to psychotic symptoms more likely to be prescribed stimulants, or is there a non-causative relationship between the two? They evaluated whether stimulant prescriptions causally increase psychotic experiences in youth, using a target trial emulation of 8,391 participants aged 9–14. In unadjusted analysis, stimulant use was associated with higher odds of psychotic experiences (OR = 1.46; 95%CI 1.15–1.84), but baseline psychotic experiences also predicted stimulant use (OR = 1.93; 95%CI 1.57–2.37). After adjusting for confounders via doubly robust estimation, no causal effect was found (OR = 1.09; 95%CI 0.71–1.56). Stimulant use and psychological symptoms were parent-reported, and no information was included about additional medications or diagnoses, nor about cumulative stimulant dose.
How does this change my practice?
These results line up with my experiences. My patients who are hospitalized for any psychiatric indication are nearly always discharged on stimulants with an ADHD and ODD diagnosis, so stimulants may just feel like a safer treatment for a variety of psychiatric issues in kids. I haven’t noted an uptick in psychotic experiences in my patients who have started stimulants, but this is great information to have on hand if a patient or their family expresses concerns.
Source
Stimulant Medication Use and Risk of Psychotic Experiences. Pediatrics. 2025 Jun 1;155(6):e2024069142. doi: 10.1542/peds.2024-069142. PMID: 40350165
