The psychostimulant Adderall is an amphetamine drug that is most commonly used to treat the symptoms of ADHD in both children and adults. It is also sometimes used for other health conditions, such as narcolepsy and other sleep/wakefulness disorders. Read on to learn how it works and what it’s officially used for.
Disclaimer: This post is not a recommendation or endorsement for Adderall. This medication is only FDA-approved for the treatment of certain specific medical disorders, and can only be taken by prescription and with oversight from a licensed medical professional. We have written this post for informational purposes only, and our goal is solely to inform people about the science behind Adderall’s effects, mechanisms, current medical uses, and potential risks.
What is Adderall?
Overview
Adderall — otherwise known as dextroamphetamine-amphetamine or just “D-amphetamine” — is one of the most commonly prescribed medications used to treat the symptoms of ADHD and several other health conditions. It belongs to a class of compounds called amphetamines, which act as stimulants in the central nervous system (CNS) through a wide variety of different mechanisms, such as by increasing levels of the major neurotransmitters dopamine, norepinephrine, and serotonin [1, 2].
Prescription Patterns
Over 3 million children have been prescribed Adderall or other stimulants to treat psychiatric conditions such as ADHD. Symptoms of ADHD include lack of focus, impulsiveness, and trouble staying still [1, 3].
Adults are also commonly prescribed Adderall. The number of American adults who take Adderall for ADHD increased by more than 90% between the years of 2002 and 2005 [4].
Adderall is so widely-used in large part because it is believed to be highly effective and well-tolerated (i.e. it causes relatively few side-effects when used properly) [5].
Potential for Abuse and Addiction
However, Adderall is classified as a Schedule II drug by the FDA, meaning that it has a high potential for abuse and addiction. This also means that it can only be legally purchased and possessed with a doctor’s prescription [1].
Additionally, there are potential downsides to stimulants like Adderall — especially when they are abused (i.e. taken without a prescription, or outside of ongoing medical supervision). In fact, stimulants are the second-most commonly abused drugs by college students, who use Adderall and other stimulants illegally in order to enhance their ability to study for prolonged periods of time [6].
The total extent of Adderall abuse among college students is difficult to know for certain, but it has been estimated that between 2-8% of all university students have abused it within the past month, while 3-16% have abused it at some point during the past year [7].
Many people abuse Adderall to improve school or work performance. Student-athletes have also been reported to abuse Adderall in order to improve their exercise performance and increase energy [1].
When not being used for performance improvements, it is also illicitly used by some people to induce a euphoric “high” [1].
While there are many different reasons that people choose to abuse Adderall, it has been estimated that a considerable proportion of this abuse occurs because students mistakenly believe that the illegal use of Adderall is “physically harmless” — which it definitely isn’t [1, 7]!
Components
Adderall consists of a mixture of several different dextroamphetamine and amphetamine salts [8]:
- Dextroamphetamine (d-amphetamine) saccharate
- D-amphetamine sulfate
- Levoamphetamine (l-amphetamine) sulfate
- L-amphetamine aspartate
“D-” (right) and “L-” (left) amphetamine are the same molecule, but they are mirror images of the same structure (“enantiomers”). Although this might sound like a minor difference, it is actually quite important that Adderall contains both L-amphetamine and D-amphetamine components. This is because they each have subtly different molecular properties and effects on the nervous system, and may, therefore, complement each other in treating disorders like ADHD [9, 10].
For example, one small-scale study of 11 children reported that L-amphetamine appeared to work better in some children, while D-amphetamine was more effective in others. Therefore, having both components is useful because it caters to both types of patients [11].
Ritalin vs. Adderall
According to one preliminary study, Adderall was reported to relieve certain ADHD symptoms (such as disruptive behavior, reduced academic productivity, etc.) more effectively than another commonly-prescribed stimulant, Ritalin (methylphenidate). The differences in these drugs’ effects were especially apparent at relatively low doses [10].
Adderall’s effects have also been reported to last longer throughout the day — sometimes as much as twice as long at higher doses. This potential longer-lasting effect is one of the reasons that doctors have been reported to prescribe Adderall up to three times more often than Ritalin [10].
Similarly, another study comparing Adderall to Ritalin (methylphenidate) in 58 children reported that Adderall was reported to work better and last longer overall [12].
How Does Adderall Work?
Adderall is classified as a central nervous system stimulant, and its stimulant properties stem from several different mechanisms.
Adderall stimulates the release of the neurotransmitter norepinephrine, by activating α- and β-adrenergic receptor sites. Adrenergic receptors are those that specifically release the neurotransmitters noradrenaline or adrenaline [6].
Stimulating the α-adrenergic receptor sites causes [6]:
- Constriction of blood vessels all over the body
Whereas stimulating the β-adrenergic receptor sites causes [6]:
- Increased heart rate
- Increased blood flow to the muscles
- Increased output of blood from the heart
Adderall also releases adrenaline in the body, which results in increased perceived energy levels [9].
Together, each of the above effects contributes to some of the physically “stimulating” effects of the drug [6].
Adderall also prevents neurotransmitters from being taken up (transported), broken down (metabolized), and stored inside neurons. This is generally achieved by blocking the molecular transporters that bring neurotransmitters from the outside of the cell to the inside of the cell, which stops their activity at the neural synapse. Specifically, Adderall blocks [13]:
- The dopamine reuptake transporter, leading to increased dopamine concentrations outside of neurons
- The noradrenaline reuptake transporter, leading to increased noradrenaline concentrations outside of neurons
This results in increased neurotransmitter activity at the neuron’s connection to the next cell (the synapse), which is a part of why the drug is referred to as a “stimulant” (i.e. it “stimulates” neuronal activity).
Amphetamines also prevent the storage of dopamine in compartments within the cell (vesicles). This increases the availability of dopamine for later use.
Finally, Adderall also inhibits the activity of various proteins and enzymes that break down dopamine (such as monoamine oxidase-A and –B), which further increases the amount of dopamine available for use in the brain [2].
Official Medical Uses of Adderall
1) Treating ADHD
Adderall is one of the most commonly-prescribed stimulants for ADHD. The drug is used mainly to increase attention and concentration, and decrease overactivity and distractedness — the core behavioral and cognitive symptoms of ADHD.
There are many studies that support Adderall’s therapeutic effects in treating ADHD. For example, many studies report that teacher, clinician, and parent ratings of how effective Adderall is at treating children with ADHD are significantly higher than the ratings given when the children are only given a placebo [14, 12, 15, 16, 17].
Additionally, one study of 154 children reported that Adderall was effective in 89% of children diagnosed with ADHD [5, 15].
According to another study of 25 children with ADHD, Adderall reportedly improved [10]:
- Rates of disruptive behavior
- Academic productivity
- Staff/parent ratings of behavior
Additionally, Adderall has been reported to improve math test scores, according to one small-scale study of 30 students with ADHD [18].
Adderall is also widely-prescribed for adults and adolescents for short-term management of ADHD symptoms. One study estimated that Adderall treatment could be considered successful in 70% of adult and adolescent ADHD patients [5, 19].
Increased Focus
Most patients that are prescribed Adderall use it to increase focus due to conditions such as ADHD. However, some people also use (or abuse) Adderall to fight the loss of focus caused by sleep deprivation [1].
One of Adderall’s main uses is to increase a type of focus called “sustained attention” or “vigilance,” which refers to the ability to stay attentive to a task for prolonged periods of time [1, 20].
Enhanced Impulse Control
One of the main subtypes of ADHD is ADHD with combined inattentive/hyperactive-impulsivity [21, 8].
Adderall helps to improve impulse control by decreasing impulsivity, hyperactivity, and sometimes even aggression [21, 8].
For example, one study of 287 adolescents reported that Adderall significantly improved hyperactivity/impulsivity in these patients [21, 8].
Additionally, according to a study of 18 children suffering from hyperactivity and aggression, Adderall was reported to decrease both symptoms in 14 of the 18 children. By comparison, the other drug tested in this study — methylphenidate — was only reported to work successfully in 11 of the 18 children, while also producing a relatively higher rate of unwanted side-effects [22].
2) Treating Narcolepsy
Although less common than treatment for ADHD, Adderall is also used medically to treat sleep- or wakefulness-related disorders, such as narcolepsy [23, 24].
Generally speaking, narcolepsy is a disorder that can cause sudden onset of sleepiness and/or chronic extreme drowsiness throughout the day. Adderall is a commonly-used stimulant to combat narcolepsy, especially when wakefulness needs to be sustained for long periods of time. One particular form of Adderall — Adderall “XR,” short for extended release — is often preferred by clinicians, as it works for longer periods of time, and is believed to have a relatively lower potential for abuse [25].
“Off-Label” Medical Uses of Adderall
Occasionally, doctors will prescribe medications to help treat conditions that fall outside of the official uses approved by the FDA — also known as “off-label” drug use [26, 27]. Usually, this is done because there is actually decent evidence that the drug may help in a given condition, although this evidence might not be quite strong enough to get full FDA approval (which generally has very strict and extensive requirements).
As always, however, always remember that the decision to use medications in this way can only be made by a licensed medical professional.
Some of the relatively more common “off-label” medical uses of Adderall include [28, 6, 27, 29, 30]:
- Depression
- Anxiety
- Bipolar disorder
- Some eating disorders, such as bulimia
Other Uses / Effects of Adderall
Limitations & Precautions
Psychostimulant medications such as Adderall also have a number of other effects and uses that have not been widely adopted by medical practitioners.
Therefore, it is important to note that these applications are not officially approved, and are not well-established in conventional medical practice.
In fact, some of these uses may even be dangerous for a person’s health, and often involve abusing this drug illegally. Therefore, the following applications have not been demonstrated to be medically useful, and are emphatically not recommended or encouraged in any way.
Weight Loss
Before Adderall became widely-used for the medical treatment of ADHD, it used to be prescribed to help reduce weight.
It is generally believed that Adderall ultimately contributes to weight loss by suppressing or decreasing appetite [31]. However, its effects on body weight may also be due to the fact that Adderall helps control impulsivity, which could theoretically play an additional role in weight loss by preventing users from impulsively snacking or eating [32].
In any case, this application is no longer considered medically valid. In large part, this is because the risks involved in using Adderall and other psychostimulant drugs in this way — such as the possibility of developing an addiction, or experiencing potentially-severe negative side-effects — do not clearly outweigh the theoretical benefits.
Ultimately, when it comes to weight management in particular, there are many considerably safer and more effective approaches than abusing drugs in order to artificially suppress one’s appetite — and illegally using psychostimulants such as Adderall to achieve weight loss is not recommended.
To learn more about safe, effective, and healthy ways to lose weight, we recommend checking out our other SelfHacked posts on weight loss:
- 24 “natural” and “complementary” approaches to weight-loss
- 50 more complementary strategies for weight-loss
- Biological mechanisms that influence body weight
Adderall Dosage
Dosage Considerations
Note: The information in this section describes typical dose information for medical applications of Adderall: it is not a guide to recreational or other non-medical use. Anyone taking Adderall by prescription should take care to follow the directions of their doctor as fully and accurately as possible to ensure optimal treatment.
In general, Adderall comes in two main forms for medical use [33, 2]:
- Extended-release capsules (Adderall XR): When taking Adderall in this form, it is advised to take the capsule in the morning, otherwise insomnia may occur at night. The pill can be taken with or without food, but it must be taken the same way each time. XR tablets should be taken once a day. They peak at 4 to 7 hours and last around 12 hours.
- Immediate-release tablets (Adderall IR): Make sure to follow the medication guide that comes with the prescription. It is advised to take the tablet in the morning or early afternoon, otherwise, insomnia may occur at night. IR tablets are usually taken twice a day. They show effects after 45 to 60 minutes and peak at 2 to 3 hours.
The different doses of Adderall sold are 5mg, 10mg, 15mg, 20mg, and 30mg. They may be in tablet form or the extended-release form. Extended-release tablets are labeled Adderall XR, while instant release tablets are labeled Adderall IR [33].
Note that if using the tablet form, these should be in a closed container away from direct sunlight, heat, or moisture, and kept at room temperature (in order to prevent the active compounds from being degraded, and therefore becoming potentially less effective) [33, 2].
If a dose is missed but it is close to the time to take the next dose, then wait until then and take the dose. Otherwise, take the dose as soon as you remember. Do not “double-up” to account for a missed dose [33].
Takeaway
Adderall is among the most commonly prescribed medications for ADHD. It has a good safety profile compared to other stimulants when used properly. However, it also has a high potential for addiction. Abuse is relatively common, and it carries serious health risks.
Official medical indications for Adderall include ADHD and, less commonly, narcolepsy. Some doctors may also prescribe Adderall off-label for mental health disorders like depression and anxiety.
On the other hand, Adderall should not be used for weight loss. No valid evidence supports the medical usefulness of this drug for weight loss, while far more data suggest it can be dangerous.
