Amphetamine-type ADHD medicines are reported for psychosis more often than methylphenidate
A reporting ratio is not a risk. What this can and cannot tell you is the whole point.
Reasonable evidence with real limitations. how we score evidence
Using VigiBase, the WHO's global database of adverse-drug-reaction reports, researchers compared how often psychotic symptoms were reported for amphetamine-type medications — dexamfetamine and lisdexamfetamine — against methylphenidate, in people aged 13 to 25. Across 13,863 reports there were 169 psychosis reports on amphetamines and 221 on methylphenidate, giving a reporting odds ratio of 1.61 (95% CI 1.26 to 2.06). Restricted to reports where the indication was ADHD, it was 1.94. Atomoxetine showed no association.
What this design can tell you is narrow, and pretending otherwise would be the mistake. A reporting odds ratio compares how often something is reported, not how often it happens. There is no denominator of people taking the drug, so no rate can be calculated from it. Reporting is voluntary and is influenced by publicity — a drug in the news gets reported more. And the comparison is against methylphenidate, not against nothing, so the result says amphetamines are reported more than methylphenidate, not that either one causes psychosis at any particular rate.
One more limit that matters if you take Vyvanse specifically: lisdexamfetamine was pooled with dexamfetamine in the exposure group. The study cannot separate them, so it says nothing about lisdexamfetamine on its own.
What it is good for is a question. If two medications treat the same condition and one is reported for psychosis more often, that is worth raising before you assume they are interchangeable.
Worth asking
Is there a reason we chose an amphetamine over methylphenidate for me, is there anything in my history or my family's that makes psychosis more of a concern, and what would the early signs look like.
Source
Psychosis with use of amphetamine drugs, methylphenidate and atomoxetine in adolescent and adults — Hakim J, Montastruc F, et al. (2024)
Reputable peer-reviewed journal
Read the source: https://doi.org/10.1136/bmjment-2023-300876
DOI: 10.1136/bmjment-2023-300876
How this was scored
- Study design
- Cross-sectional study / survey
- Funding
- No external funding
- Published in
- Reputable peer-reviewed journal
- Sample size
- 13,863
- Preregistered
- No
- Conflicts disclosed
- Yes
- Independent of proponent
- Yes
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published August 5, 2026. Last verified August 19, 2026.
Questions
How strong is the evidence behind this?
Resolv rates this source "moderate evidence". Reasonable evidence with real limitations. It scores 68 out of 100 on our published rubric. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Psychosis with use of amphetamine drugs, methylphenidate and atomoxetine in adolescent and adults — Hakim J, Montastruc F, et al. (2024). Published in: Reputable peer-reviewed journal. DOI: 10.1136/bmjment-2023-300876. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Cross-sectional study / survey. Funding: No external funding. The researchers were independent of whoever benefits from the result. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is lisdexamfetamine (Vyvanse) FDA approved?
Yes — this medication carries FDA approval. Approval is always for a specific indication, not for every use it is prescribed for.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.