Stimulants are one of the most commonly abused drugs in the United States. This drug class includes drugs like amphetamines, methylphenidate, anorectic stimulants, and drugs like Provigil, as well as illicit street drugs like methamphetamine. Most are used to treat attention disorders, narcolepsy, weight gain, etc., but millions of Americans abuse them. In fact, according to the National Survey on Drug Use and Health, 1.3 percent of the adult population, or 3.7 million adult Americans abused a stimulant prescription in the year 2020. A further 2.5 million people abused methamphetamine, with an estimated 1.6 million struggling with methamphetamine use disorder. Yet stimulants can have significant and permanent effects on the body. Stimulant-induced psychosis is one of those issues, and occurs during or shortly after ingesting stimulants, or quitting them.
Understanding how stimulant-induced psychosis works and what the risks are can help you to make better choices around stimulant drugs.
Stimulant abuse can cause psychosis by changing hormone and chemical ratios in the brain, literally creating symptoms of psychosis. In this case, the psychosis typically goes away within 3-18 months following the final dose of stimulants.
On the other hand, stimulants can also trigger underlying mental health problems, bringing a disorder you already had to the forefront. For example, individuals with schizophrenia, bipolar disorder, and other mood disorders are significantly vulnerable to substance abuse. At the same time, abusing those drugs can worsen symptoms and result in permanent psychosis, which was triggered by the substance use.
This means that if you start to experience psychosis during stimulant abuse, it may be because of the drugs or it may be because the drugs triggered a pre-existing disorder which was not previously active.
For this reason, it’s a good idea to discuss your concerns, your family mental health history, and any diagnoses you have with your doctor when getting a prescription. If you have a risk of schizophrenia or mood disorder diagnosis, your doctor may opt for a medication with fewest possible risks. On the other hand, if you have no family history of schizophrenia or psychosis, your risks are likely extremely small and you can safely take prescription stimulants.
It’s important to note that at prescription doses, stimulants rarely cause psychosis. However, they do cause psychosis. An estimated 0.1% of patients starting amphetamine treatment for ADD or ADHD report symptoms of psychosis beginning within a few weeks of starting treatment. Yet, when you go to recreational use, those numbers skyrocket to 18%. For methamphetamine users, those rates can be as high as 70%.
Therefore, there’s risk of psychosis even with prescription stimulant use. However, risks are significantly higher as you increase the dose.
If you’ve been prescribed stimulants and you’re concerned, talk to your doctor. It’s always important to report any unusual side effects including psychosis, to your doctor – because they will take you off the medication and try something else. However, on average, prescription stimulants are safe to use as-directed.
There are many types of stimulants, however, most interact with the brain in broadly the same ways. For example, most increase levels of serotonin, dopamine, and norepinephrine in the brain. These go on to regulate the brain, enhancing attention span, increasing motivation to do things, and improving ability to sleep. In high doses, they can also cause intense highs and feeling good. But, in high doses, the brain will actually re-regulate its own production to adapt to those high levels of chemicals. The brain may even stop producing those neurotransmitters. High levels of dopamine and serotonin can also damage the receptors, meaning that you can no longer properly regulate and use those transmitters without giving the brain time to heal.
That can go on to result in significant side effects, including psychosis, depression, paranoia, feelings of hostility, insomnia, mood swings, and an inability to concentrate. And, those symptoms will likely keep coming back, to the point where you actually have to use to feel normal.
Most importantly, the longer and heavier substance abuse is, the worse those symptoms will get. Eventually, psychosis can get to the point of failing to recognize reality around symptoms.
Stimulant-induced psychosis can be difficult to impossible to tell from any other type of psychosis. For this reason, you cannot get a diagnosis for a psychotic disorder without quitting substance abuse for a period of at least 3 months. However, psychosis typically includes:
Those symptoms typically map to mood swings, significant personal decline, and cognitive decline. Someone might behave in ways that seem completely irrational and illogical, because their brain isn’t functioning as it should.
There’s a persistent myth that once you start abusing meth or another stimulant, you’re permanently damaged. That isn’t the case. In fact, most people recover fully from psychosis after a period of about 2 years after quitting stimulant abuse. That won’t be true if psychosis results from an underlying mental health disorder. However, studies show that subjects return to normal brain activity within 2 years of quitting. In fact, most healing is done within the first three months – meaning that the worst of the symptoms will go away during early recovery. However, you may need medication to manage psychosis for several years following stimulant abuse. That’s okay, millions of Americans have problems with psychosis and medication allows them to live very normal lives.
If you or a loved one is struggling with a substance use disorder, it’s important to get help. The sooner you quit, the lower the risks of developing permanent damage. And, the sooner you quit, the faster you can heal and get back to your life.
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