From the Guidelines
Taking Adderall for 20 years can lead to long-term effects such as increased blood pressure and heart rate, reduced height and weight gain, and potential cardiovascular risks.
Long-term Effects of Adderall
- Cardiovascular Risks: Studies have shown that stimulant medications, including Adderall, are associated with statistically significant increases in blood pressure and heart rate 1. While these effects are small on the group level, they may be clinically relevant for a small subgroup of patients, especially those with preexisting cardiovascular diseases.
- Reduced Height and Weight Gain: Findings from longitudinal studies indicate that treatment with psychostimulants, including Adderall, is associated with a statistically significant reduction in height and weight gain 1. These effects are usually minor, but can be clinically relevant in subgroups and generally require careful monitoring.
- Monitoring and Maintenance: Clinical guidelines generally recommend monitoring of pulse and blood pressure when prescribing psychostimulant medication, including Adderall 1. Regular assessment of medication adherence and potential issues in adherence is also crucial to increase medication adherence and minimize risks.
Important Considerations
- Individualized Treatment: The complex construct of ADHD implies that a “one-size-fits-all” approach cannot be adequate and helpful in guiding the decision for a medication, including Adderall 1. All relevant factors, such as severity of symptoms, presence of comorbidities, and patients' preferences, need to be considered.
- Dosing Regimen: The dosing regimen can also affect medication adherence, and once-daily dosing should generally be preferred over twice-daily dosing 1.
- Long-acting Formulations: Long-acting formulations of stimulant medications, including Adderall, are available and can provide better medication adherence and probably a lower risk of rebound effects 1. However, the choice of formulation should be individualized based on the patient's symptom profile and needs.
From the FDA Drug Label
DRUG ABUSE AND DEPENDENCE Dextroamphetamine sulfate tablets are a Schedule II controlled substance. Amphetamines have been extensively abused. Tolerance, extreme psychological dependence and severe social disability have occurred. ADVERSE REACTIONS ... There have been isolated reports of cardiomyopathy associated with chronic amphetamine use. Manifestations of chronic intoxication with amphetamines include severe dermatoses, marked insomnia, irritability, hyperactivity and personality changes. The most severe manifestation of chronic intoxication is psychosis, often clinically indistinguishable from schizophrenia.
The long-term effects of taking Adderall (amphetamine and dextroamphetamine) for 20 years may include:
- Tolerance and extreme psychological dependence
- Severe social disability
- Cardiomyopathy (isolated reports)
- Severe dermatoses
- Marked insomnia
- Irritability
- Hyperactivity
- Personality changes
- Psychosis (rare) 2 2
From the Research
Long-term Effects of Adderall
The long-term effects of taking Adderall (amphetamine and dextroamphetamine) for 20 years are not well understood, but several studies provide some insights:
- A study published in 2012 3 discussed the misuse of prescription stimulants, including Adderall, and the associated risks, such as psychosis, myocardial infarction, cardiomyopathy, and sudden death.
- A review of ADHD medication overdose published in 2013 4 reported that amphetamine and dextroamphetamine can cause excessive extracellular dopamine, norepinephrine, and serotonin, leading to prominent neurological and cardiovascular effects.
- A case-control study published in 2024 5 found that long-term exposure to ADHD medications, including Adderall, was associated with an increased risk of cardiovascular diseases, especially hypertension and arterial disease.
- An animal study published in 2013 6 found that chronic administration of d-amphetamine from childhood to adulthood increased the survival of new neurons in the hippocampus of male mice.
- A review of Adderall toxicity published in 2013 7 reported that overdose can cause hyperactivity, hyperthermia, tachycardia, tachypnea, mydriasis, tremors, and seizures in humans and dogs.
Cardiovascular Risks
The study published in 2024 5 found that longer cumulative duration of ADHD medication use was associated with an increased risk of cardiovascular diseases, including:
- Hypertension
- Arterial disease
- Ischemic heart diseases
- Cerebrovascular diseases
- Heart failure
- Arrhythmias
- Thromboembolic disease
Neurological Effects
The animal study published in 2013 6 found that chronic administration of d-amphetamine increased the survival of new neurons in the hippocampus, which may be beneficial for ADHD treatment. However, the review of Adderall toxicity published in 2013 7 reported that overdose can cause severe neurological effects, including seizures and hyperthermia.
Clinical Implications
The studies suggest that long-term use of Adderall may be associated with increased cardiovascular risks and neurological effects. Clinicians should carefully weigh the potential benefits and risks of long-term ADHD medication use and regularly monitor cardiovascular signs and symptoms throughout the course of treatment 5.