The misuse of ADHD drugs – and what they really do to your body and brain

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Be more alert; improve your focus; do better at work: these are the reasons why high-flyers, from surgeons to lawyers and bankers, take 'brain-doping' ADHD drugs despite not having the condition. Now, increasing numbers of elite athletes are joining them, looking for something extra to give them the competitive edge. But taking ADHD drugs when you don't need them will certainly do more harm than good, with many takers becoming more irritable, experiencing sleep disruption and, in the most serious cases, causing heart problems, anxiety and depression.Sportspeople are barred by the World Anti-Doping Agency from taking ADHD medications such as Ritalin and Adderall before competing, but those who have been diagnosed with ADHD are exempt, on the grounds that they need the drugs to function. Such exemptions have tripled in the last five years, so suspicion has turned to the 'subjective assessments' by doctors to diagnose athletes with ADHD in adulthood, John Brewer, a former UK Anti Doping board member told The Telegraph last month. There has been a known black market for ADHD drugs ever since they became available to buy online, with packets of Ritalin, the drug most commonly prescribed to people with ADHD in Britain, selling for less than £20 on the websites of unscrupulous online pharmacies. It's more common, however, for stressed students and professionals alike to acquire spare pills from friends and family. In fact parents, who believe they have ADHD but have never been diagnosed, have been known 'to take stimulants that have been prescribed for their children because they think it helps them to perform better', says Katya Rubia, professor of cognitive neuroscience at King's College London.
In Britain, the drug most commonly prescribed for ADHD is Ritalin, the brand name for the drug methylphenidate – a type of stimulant drug. Adderall, another stimulant drug, is typically prescribed in America, and sometimes finds its way into the hands of British students (or professionals) illegally. There is an important distinction between 'misuse' of ADHD drugs – taking them in their prescribed doses when you don't have ADHD – and 'abuse', which means taking large amounts of Adderall or Ritalin for a high, says Prof Rubia. ADHD drugs are considered to be 'very safe' in the small doses prescribed to treat the condition, adds Prof Rubia, but abusing the drugs can cause heart palpitations, stomach aches and can be 'neurotoxic'. 'They actually change your brain's dopamine system, producing effects like anxiety and depression, as well as inattention and difficulties with memory,' she adds. In other words, abusing ADHD drugs can leave you with a set of symptoms that look a lot like ADHD.
Prof Rubia also strongly advises against misusing ADHD drugs because 'you shouldn't take ADHD drugs at all if you don't have ADHD; you're a healthy person and the side effects are unnecessary'.
You might believe that taking ADHD drugs when you don't have ADHD would make you think more sharply, but that's far from the truth. ADHD drugs 'work on your brain's dopamine system, to increase the amount that your brain has available to use,' says Prof Rubia. People with ADHD 'don't have enough dopamine, so struggle with motivation, concentration and focus, as well as keeping time and controlling their own behaviour, especially in children'.
Taken by people without ADHD, the drugs might improve alertness, but they have a negative impact on other functioning, due to the 'U-shaped' impact of the levels of dopamine in your brain: past a certain point, your attention, focus and motivation will suffer. 'If you don't have ADHD, you already have an optimal amount of dopamine in your system, so increasing it will make you perform worse,' Prof Rubia says.
One study, published in 2023, gave three groups a common 'smart drug' (Adderall, Ritalin or Modafinil, which is prescribed for narcolepsy in Britain) and observed how it affected their performance in a problem-solving task. 'When taking any of the drugs, the participants tried harder, but performed less well,' says Peter Bossaerts, professor of neuroeconomics at the University of Cambridge, who led the study. Those who performed best without the drugs 'performed below the mean when they were on them,' he adds. 'So they aren't really smart drugs. They make you dumber, but more busy and more motivated.'Another study, using a similar task to assess cognitive performance, found again that 'people who took 'smart drugs' performed worse despite trying harder,' Prof Bossaerts says. Here, worsened memory seemed to be behind the decline in ability. 'Dopamine doesn't only affect motivation, but also your memory, and drugs like Ritalin work on the dopamine receptors in your prefrontal cortex' – the part of your brain that manages your working memory and lets you retrieve memories from the past, Prof Bossaerts points out.The effects of taking so-called 'smart drugs' (also known as 'study drugs') are also short-lived. 'Students who take them might feel a bit down and sluggish for a few days after their exams, but they'll quickly pick up again in most cases,' says Prof Bossaerts. Abuse, or taking large amounts of Adderall or Ritalin for a high, is another matter. This means that the drugs have a 'high potential for abuse', even if you start out taking them occasionally to pull an all-nighter or meet an important deadline, Prof Rubia believes. 'As your body gets used to them, you need more and more to feel the same effects.' The way in which ADHD drugs are prescribed for people who require them is vital. 'Over months or years you will see their effects decline over time' explains Prof Rubia. 'ADHD drugs are the best kind of psychiatric medicine we have available, because in small doses they are so safe and the side effects are so minimal. But they do quickly decrease in efficacy over time as the brain gets used to them. To counter this in people with ADHD, we give people 'holidays' where they stop taking their prescription for a while or slowly increase the dose over time.'
The huge climb in athletes diagnosed with ADHD in adulthood is no coincidence, says Prof Rubia, as use of the drugs has long been commonplace in sports. That said, a significant proportion of athletes who have been diagnosed with ADHD as adults may well have the condition. A Taekwondo black belt or football star probably has a higher likelihood of having the condition than the average person, Prof Rubia believes. 'People with ADHD are very often good at sports,' she explains. 'They have more energy than the average person, and where academics might have been a struggle at school, they might have realised their talent for sports and pursued that instead.' Intense sports practice can also be an effective tool for managing ADHD symptoms. Prof Rubia recalls meeting an Olympic karate fighter who had 'managed to overcome his ADHD without medication by training in a very focused way'.A sportsperson who takes ADHD drugs without having ADHD, however, might be in for a shock. Though the drugs might improve performance in the short term by making athletes 'feel less tired and more alert, as if they've had a lot of coffee,' Prof Rubia says people misusing the drugs over weeks or months might find themselves feeling less motivated and alert than they were before. 'Even within a day, they'll feel more low by the evening than they otherwise would.'Whether you're an athlete or not, taking stimulant ADHD drugs when you don't have the condition 'will affect your body in very similar ways these drugs affect the bodies of people with ADHD who take them,' says Prof Rubia. Stimulants increase your heart rate and blood pressure and can also reduce your appetite, while making you feel more awake and alert. People who take Ritalin also report some personality changes, like being more irritable and on edge, as well as worsened sleep, but both can also be symptoms of ADHD itself. Some research has indicated, however, that long-term use of ADHD medications (in people with and without the condition) may lead to an increased risk of cardiovascular disease. Weight loss and headaches are common, as are gut problems, though side effects like these are usually mild. In children who take ADHD medication, 'there's some evidence that it stunts growth slightly compared to how tall a child's parents are,' Prof Rubia adds.All in all, to better understand how these drugs affect our bodies 'we need more studies that observe the effects of ADHD drugs on both the healthy population and on people who have ADHD,' says Prof Rubia. Anecdotally, though, the physical impact of taking ADHD drugs when you don't need them is clear, Prof Bossaerts says with a sigh: 'I remember a student once passing out in front of me because he'd taken 'study drugs' over his final exams and had been awake for three days in a row at that point.'
At best, it's counterproductive but, at worst, taking so-called 'smart drugs' can be a real danger to your health – not such a smart move after all.
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