Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that affects millions of people each year in the United States. Though mainly seen in children between the ages of three and 17, ADHD is also estimated to affect about 2.5% of the adult population. Since the disorder first started to be diagnosed more regularly in the 1990s, the standard treatment has been the medication known as Adderall. Also sometimes used for the treatment of narcolepsy, Adderall is a combination prescription drug that is known to have numerous side effects, including weight loss.
Adderall is one of the trade names for a medication that contains mixed amphetamine salts; the two main components, racemic amphetamine and dextroamphetamine, are compounds that act as stimulants in the central nervous system. As a neurodevelopmental disorder, ADHD is characterized by hyperactivity, difficulty paying attention, and bouts of impulsiveness. Also, like narcolepsy, people with ADHD tend to experience sleep disturbances or drowsiness during the day. Adderall is prescribed to counteract this through its effect on the relevant brain chemicals.
The precursor of Adderall, Obetrol, contained methamphetamine and was a popular obesity treatment in the 1950s and 60s. After changes to the rules for reviewing drugs that contain amphetamines, the Food and Drug Administration withdrew its approval. The pharmaceutical company that developed the drug eventually reformulated it without methamphetamine and continued to sell it without FDA approval. Later, after Obetrol was purchased by a new company, it was rebranded as Adderall and began being used to treat ADHD; the FDA then granted approval for the new formulation in 1996.
To understand how Adderall works, it’s helpful to look at the basics of the ADHD disorder. Though the precise cause of ADHD is not fully understood, the current thinking is that it stems from an imbalance of the neurotransmitters dopamine and norepinephrine. These neurotransmitters are involved in a variety of cognitive functions, including interacting with the areas of the brain responsible for motivation and reward. Low levels of dopamine and norepinephrine tend to lead to classic ADHD symptoms like inattentiveness and decreased motivation.
The principal components of Adderall—amphetamine and dextroamphetamine—mimic the effects of dopamine and norepinephrine and in the right dosage can bring the brain chemicals into balance. Dopamine is associated with the pleasure and reward centers of the brain, and increasing those levels can spur the motivation to take action and achieve goals. Norepinephrine is a stress hormone connected to the flight-or-fight response as well as generally preparing the brain and body for action. Adderall has had a lot of success at helping people find the focus and motivation that previously eluded them.
Unfortunately, the nature of Adderall and its effect particularly on dopamine and the pleasure center of the brain makes it highly susceptible to misuse and addiction. Indeed, Adderall abuse is a known issue that affects many people; in fact, it is often referred to as a “study drug” on college campuses because of the short bursts of attention and focus it can bring the user. Yet, as with other types of drug abuse, a person’s tolerance level can go up and more and more is needed to achieve the same effect; eventually this can lead to numerous medical and mental health problems.
Because of the potential for abuse, Adderall is a Schedule II controlled substance in the same category as numerous illegal drugs. Yet when taken under a doctor’s supervision and within the prescribed dosage amounts, it is a relatively safe medication with few serious adverse effects. Below are examples of some potential side effects:
Another side effect of ADHD medications like Adderall and a similar prescription drug Ritalin (methylphenidate) is weight loss, and there has even been some research into whether such stimulant drugs at lower doses might be effective at treating obesity through appetite suppression. Currently, however, neither drug is FDA approved for weight loss, and the higher doses used to treat ADHD and ADD (attention deficit disorder) are not considered safe. It would be particularly dangerous for people with health conditions related to the cardiovascular system.
One of the main drivers of weight loss for people on Adderall is the loss of appetite. Some recent research has uncovered a connection between dopamine receptors and satiety, the feeling of fullness after eating. This means that increased dopamine levels from taking Adderall can lead to a feeling of fullness even when a person is not actually full. For someone with an obesity problem, this might stem the tendency toward overeating, but in others it can lead to a regular calorie deficit and eventual reduced body mass index (BMI).
The other way that Adderall use can contribute to weight loss is through its effect on metabolism. The neurotransmitter norepinephrine is linked to energy metabolism because of how it can increase blood pressure and heart rate as part of the stress response. This increase in heart rate by default requires more energy, so more glucose gets converted. An increased metabolic rate combined with a reduced appetite makes weight loss more likely.
Though weight loss is a realistic possible side effect, there are also ways that ADHD and the relationship with Adderall may actually lead to weight gain as well. For reasons that aren’t fully understood, people with ADHD are many times more likely to be overweight than those without; this may be in part because of impulse control as well as the dopamine imbalance. Children who take Adderall early in life may then find great difficulty in controlling appetite later on when they are no longer on the medication.
Adderall is known as an effective treatment for ADHD, and it may even lead to welcome weight loss. But the way the drug affects various neurotransmitters in the brain raises the potential for abuse, especially compared to FDA-approved weight loss drugs. The idea of a drug that helps you focus and helps you lose weight is appealing but ultimately dangerous. Moreover, the chances are high that any weight loss will be gained back not long after the conclusion of the medication.
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