What you should know about prescription Adderall

Trying to describe the attention deficit hyperactivity disorder (ADHD) experience can be challenging. We’ve seen the my-brain-has-too-many-tabs-open memes. The TV characters flutter unfocused around the screen. But the condition is more complex than that, manifesting in ways that can affect daily life for both children and adults. For those people, Adderall could be a game-changer. 

Adderall is available via prescription from primary care physicians, nurse practitioners, neurologists, or psychiatrists. But determining whether someone needs it is challenging, and because it’s a controlled substance, getting a prescription can be, too. Here’s the scoop on who could benefit from Adderall, who should avoid it, and how it is prescribed.

Do you need an Adderall prescription?

Not everyone expressing the need to cram for a test or casually attributing forgetfulness to ADHD requires medication. However, there are adults who could benefit from ADHD medication like Adderall, Ritalin, Strattera (atomoxetine), Concerta, or Vyvanse.

While ADHD diagnoses are more common in children, it also affects over 366 million adults worldwide, according to the Journal of Global Health. The issue is that the symptoms of ADHD can overlap with certain mood disorders and other mental health conditions, like anxiety and depression.

There’s no overarching test for ADHD, so doctors often use a combination of methods to diagnose it. Dr. Ryan Sultán, MD, a psychiatrist at Integrative Psych and assistant professor of clinical psychiatry at Columbia University, says he starts with a comprehensive clinical interview. “This involves detailed discussions with the patient, and often with their family members or others close to them, to understand the patient’s behavior patterns, lifestyle, and personal history,” he says. “I also use behavioral rating scales and questionnaires, like the Vanderbilt Assessment Scale or the Conners’ Rating Scale, completed by the patient, parents, or teachers to evaluate the presence and severity of ADHD symptoms,” along with other psychological tests. 

Typically, if five or more ADHD symptoms of inattention or impulsiveness continually affect a person’s everyday life and work or school performance, they may benefit from a prescription medication. Some of these symptoms include:

• Difficulty focusing
• Impulsiveness
• Difficulty multitasking
• Low tolerance for frustration
• Mood swings
• Difficulty dealing with stress
• Fidgeting
• Excessive talking
• Lack of follow-through
• Forgetfulness
• Constant restlessness

Adderall addresses these symptoms with two central nervous system stimulants: amphetamine and dextroamphetamine. When these substances reach the brain, they elevate dopamine and norepinephrine neurotransmitters.

Dopamine regulates the brain’s pleasure center, which can reinforce rewarding behaviors, improve attention, and lessen the need for self-stimulatory behaviors. A sibling of dopamine, norepinephrine is a stress hormone that helps control attention and alertness and influences heart rate, breathing, and muscle contractions. Together, they kick the brain into gear and help sustain its focus.

That increase in alertness and energy has made Adderall popular among college students pulling all-nighters. According to Ashley Murry, LCSW, Chief Clinical Officer at Sana Lake Recovery, “Adderall can be useful for people with ADHD, but it has gained a reputation for helping people focus and improve study performance, and this can compel certain people to try and access the substance inappropriately. Non-medical use of Adderall can be extremely dangerous and is never advisable.” Studies have shown that in people who don’t have ADHD, these medications may increase their motivation but decrease the quality of their cognitive function. 

Overall, Dr. Sultán says, the decision to prescribe Adderall depends on “the severity and impact of ADHD symptoms on the patient’s daily life, their medical history, and how they’ve responded to other treatments. Age is also a crucial factor since stimulant medications like Adderall are typically more suited for certain age groups.”

Who should not take Adderall?

Whether it comes from a pharmacist or changes hands in a dorm room hallway, it’s clear—people want Adderall. But it’s not a good option for everyone. Not only can it have harmful side effects in people who don’t have ADHD, but it may interact with various conditions and drugs. Here’s who shouldn’t take it.

Anyone with heart issues

Adderall can increase heart rate and blood pressure, which may worsen or increase the risk of cardiovascular conditions like hypertension, coronary artery disease, or arteriosclerosis. In extreme cases, it may also cause heart attack or stroke in people with these conditions.

People with hyperthyroidism

The symptoms of an overactive thyroid, which include an increased heart rate and blood pressure, overlap with the side effects of Adderall. So, for people with hyperthyroidism, Adderall may intensify their symptoms.

Pregnant women

There’s not a ton of research on the effects of Adderall on developing fetuses, so many doctors are hesitant to recommend it during pregnancy. The U.S. Food and Drug Administration (FDA) classifies it as a category C drug, meaning animal studies have found adverse effects on the fetus. Still, there are no satisfactory human studies yet.

Certain people with glaucoma

According to the American Academy of Ophthalmology, Adderall is safe for people with open-angle glaucoma, in which eye pressure can slowly increase. However, for people with closed-angle glaucoma, Adderall can cause sudden spikes in eye pressure, which may cause vision loss.

People with severe anxiety

The uptick in dopamine Adderall provides might make it attractive to people who have anxiety. But that’s an off-label use, and while it might help to quell overthinking momentarily, the boost in norepinephrine could exacerbate anxiety symptoms. 

Anyone with a history of addiction

“There is a mistaken belief that if a substance is prescribed, that automatically makes it safe, but this isn’t always the case,” says Murry. “Adderall can be misused even when prescribed, so it’s important to monitor and manage patients’ use effectively.”

Because Adderall “has a strong potential to lead to dependency,” she says, “it is often advisable for those who are in recovery from a substance use disorder to seek an alternative. Similarly, if a person has a family history of substance use disorder, they may choose to avoid it.”

Children under age three

Adderall is only approved for children ages three and up. Adderall XR—the medication’s extended-release version—is only suitable for ages six and up.

Anyone taking certain antidepressants or stimulants

Like Adderall, monoamine oxidase inhibitors (MAOIs)—a class of antidepressants—can elevate blood pressure, pushing it to dangerous levels if taken together and increasing the risk of heart attack, stroke, and even death. Doctors recommend not taking Adderall until at least two weeks after the last dose of an MAOI. Other antidepressants, like SNRIs and SSRIs, can potentially cause serotonin syndrome when taken with Adderall, although they may be prescribed together cautiously at lower doses.

Since Adderall is a stimulant, anyone taking it should be cautious of taking other stimulants simultaneously. Adipex-P, Sudafed, and even caffeine can increase heart rate and blood pressure. It’s a good idea to avoid them if possible when taking Adderall, or talk to a doctor about safe ways to take them.

How to get an Adderall prescription

The first step is visiting a primary care physician. They can make an ADHD diagnosis or provide a referral for a neurologist, psychiatrist, or other ADHD specialist. Many doctors will not prescribe Adderall without first completing an ADHD evaluation. After the exam, if they think the medication might help, they’ll write a prescription. Often, more detailed neuropsychiatric testing is required before ADHD medication is started.

The Drug Enforcement Administration (DEA) classifies Adderall as a Schedule II controlled substance, which means it has a high potential for abuse and psychological or physical dependence. That’s why pharmacies are prohibited from refilling it.

However, according to the FDA, medical doctors can provide multiple scripts amounting to a 90-day supply, as long as they’re for a legitimate medical purpose, include written instructions, will not create an undue risk of abuse, and comply with state laws. “For renewals, regulations vary by region, but generally, ongoing medical supervision is mandatory,” says Dr. Sultán. “This usually involves regular appointments to monitor the effectiveness of the medication, assess any side effects, and evaluate the ongoing need for the medication.”

Patients should always go through a doctor since unauthorized sources can be dangerous. “Adderall must be properly prescribed to be safe and effective, and the dose is tailored to the individual. Therefore, a person should always go through the proper channels to access or renew their prescription. “

Getting an online Adderall prescription

The rise of telehealth has made healthcare professionals and medical advice more accessible than ever. But there are still some treatments that require in-person oversight—and until 2020, Adderall was one of them. During the COVID-19 epidemic, the DEA enacted a policy that allowed healthcare providers to prescribe controlled substances remotely. Before that, these prescription drugs required an in-office evaluation.

The policy was set to expire until the DEA renewed it through 2024. So, for 2024, telemedicine is still a viable way to get an Adderall prescription. In the future, though, it may return to requiring an in-person exam.

The first step in getting an Adderall prescription online is finding a licensed telehealth provider in your state. Telehealth doctors can prescribe medications across state lines, but each state has regulations. After a virtual consultation, they’ll decide whether they think you could benefit from ADHD medication and, if so, write a prescription. You can take that prescription to an online or brick-and-mortar pharmacy to fill it.

When searching for online pharmacies,  beware of scams and unlicensed providers. The FDA says a trustworthy mail-order pharmacy will always require prescriptions and have a licensed pharmacist on staff, and provides several tips on how to spot unreliable sources.

Who can prescribe Adderall?

Only licensed physicians can prescribe medications, and since Adderall is more highly regulated, doctors must also register with the DEA to prescribe it. Primary care physicians are often qualified—and in many states, nurse practitioners are too—but not every PCP or NP will prescribe Adderall immediately. Some may refer patients to a neurologist or psychiatrist for further evaluation. These specialists are also authorized to prescribe ADHD medications like Adderall and Ritalin (methylphenidate).

Are there over-the-counter ADHD medications?

Whether they’re having trouble renewing a prescription or just looking to avoid some of Adderall’s potential side effects, people with ADHD might want more natural, over-the-counter ADHD treatment options. While there are no direct Adderall alternatives available, certain supplements, non-stimulant medications, lifestyle changes, and therapies might provide similar effects. A few of the most common are:

• Zinc: Research has suggested that children with ADHD may have lower zinc levels.
• B Vitamins: Studies have associated vitamin B2, B6, and B9 deficiency with higher ADHD diagnosis rates and symptom severity.
• Pycnogenol: Also called French Maritime Pine Bark Extract, studies compared this supplement to methylphenidate for ADHD treatment in children, and while it wasn’t quite as effective, it still improved hyperactivity, impulsivity, and inattention.
• Ginkgo biloba: This antioxidant, derived from the maidenhair tree, has shown some effectiveness in improving ADHD symptoms and electrical brain activity in children.
• Ginseng: One study found that ginseng supplementation decreased inattention and hyperactivity in children.
• Caffeine: Like Adderall, caffeine is a stimulant, and some studies have suggested it can have similar effects on ADHD symptoms. Ultimately, though, the research is inconclusive.

Lifestyle changes may also play a role in ADHD treatment. For example, maintaining a consistent sleep schedule is essential for brain health in general. Mental and physical exercise is equally important, as studies have shown that exercise can improve the symptoms of ADHD in children. A healthy, well-rounded diet may also improve ADHD and overall health.