Do stimulants such as Adderall work for depression?

If you’re feeling depressed, it’s important to know that there’s treatment out there that can help. Many experts recommend starting with a combination of psychotherapy and antidepressant medication—commonly either a selective serotonin reuptake inhibitor (SSRI) or a serotonin-norepinephrine reuptake inhibitor (SNRI).

But in some cases, that might not be quite the right solution. For some people, they may need to add another medication to their treatment and are wondering if a medication like Adderall could be right. 

Adderall is a brand name for a medication that’s a combination of two central nervous system stimulants: dextroamphetamine and amphetamine. This medication, which belongs to the class of drugs called stimulants, is often used to treat the symptoms of attention deficit hyperactivity disorder (ADHD). It’s also approved by the U.S. Food and Drug Administration (FDA) as a treatment for narcolepsy. 

When using Adderall off-label for depression, there are many things prescribers consider. Here’s what you need to know. 

Does Adderall help with depression?

For depression, “Adderall is not a first-line of treatment,” says Jack Drescher, MD, a psychiatrist and psychoanalyst in private practice in New York City and past president of the Group for the Advancement of Psychiatry (GAP). In some cases, stimulant medications may be considered as an augmentation to treatment. Meaning, if someone is experiencing a case of treatment-resistant depression, it might be appropriate to consider adding another medication to see if it helps. 

Adderall and other stimulants work by enhancing the effects of certain chemicals in the brain, neurotransmitters that include dopamine, epinephrine (adrenaline), and norepinephrine. They help increase a person’s ability to focus and enhance memory and executive function. Other common stimulants to treat ADHD and narcolepsy include Vyvanse (lisdexamfetamine), Ritalin (methylphenidate), Provigil (modafinil), and Zenzedi (dextroamphetamine). These stimulants, including Adderall, are not typically used to treat depression. SSRIs are the most commonly prescribed type of antidepressant—and they are approved by the FDA for this purpose. SNRIs are also very commonly used to help people manage depressive symptoms. 

There is very little data regarding the use of stimulants for depression. Still, studies suggest they can be helpful in adults with unipolar depression with treatment-resistant depression, especially in patients who have failed other augmentation strategies or those who are experiencing fatigue, hypersomnia, and impaired concentration. 

“Stimulants can have mood-elevating effects, and they can be helpful with a specific type of depression, [like someone who has an] inability to even perform daily tasks like showering and getting out of bed,” says Ryan Sheridan, PMHNP-BC, an integrative psychiatric nurse practitioner in Washington, D.C. “Someone who suffers from depression internally and is always go-go-go likely wouldn’t benefit in the same way that someone who cannot get out of bed.”

Some providers will prescribe Adderall or another stimulant medication off-label to help some patients who are struggling to find a treatment or combination of treatments to help them manage their mental health conditions. However, stimulants are not effective treatments for depression by themselves and should be used only to augment other antidepressant medications.  

Adderall dosage for adults with depression

As Adderall is not an approved treatment for depression, there’s not a standard dosing recommendation for this purpose, says Dr. Drescher. It comes down to clinical decision-making by the prescribing provider. 

Adderall comes in regular and extended-release formulations, and the dosing depends on the strength as well as the age of the person taking it. When taken to manage ADHD symptoms, adults can start with a 5 mg dose, taken once or twice per day. With the extended-release formulation (known as Adderall XR), adults typically take one 20 mg dose in the morning. For managing narcolepsy, adults can take 10 mg per day, divided into two doses.

According to Dr. Drescher, he might consider adding a small dose of Adderall if someone was already taking the maximum dose of antidepressant medication and was still having serious trouble. “So I might start them with 5 mg of Adderall, which is a low dose, and then titrate upward,” he says. 

Dr. Drescher adds that stimulants aren’t the only option for augmented depression treatment, and many would be preferred by providers before stimulants. “Some people even use low doses of antipsychotics,” he says. There are two categories of antipsychotic medications: first-generation, or typical, antipsychotics, and the newer second-generation, or atypical antipsychotics. Atypical antipsychotics include prescription medications like Abilify or Aristada (aripiprazole) and Risperdal or Perseris (risperidone). It would also be possible to use other medications to augment treatment, which could include thyroid medication, Buspar, or lithium.

When to discuss stimulants such as Adderall for depression with your healthcare provider

It can take some trial and error to find the right antidepressant, the right dosage, or even a possible combination of treatments that are effective for you. If you are struggling to find a treatment regimen that works for you, talk to your healthcare provider.

Dr. Drescher notes that not every healthcare professional will feel comfortable prescribing certain controlled substances to patients with depression. It’s possible that only a provider familiar with your medical history and experienced in psychopharmacology, such as a psychiatrist or a psychiatric nurse practitioner, would prescribe a stimulant for depression. Stimulants are Schedule II controlled substances, which means they have a high potential for substance abuse, and their use can potentially lead to “severe psychological or physical dependence,” according to the U.S. Drug Enforcement Administration (DEA). 

Before a provider prescribes a stimulant to adults with depression, they will consider potential adverse reactions in patients, such as addiction, anorexia, mood changes, psychosis, and cardiovascular problems.

Stimulant side effects 

According to the Cleveland Clinic and the Mayo Clinic, common but less serious effects of stimulants include:

• Anxiety or nervousness
• Physical dependence (addiction)
• Blurry vision
• Dry mouth
• Loss of appetite
• Weight loss
• Stomach pain
• Headache
• Nausea 
• Trouble sleeping
• Changes in sex drive

More serious side effects of Adderall and other stimulants may include chest pain, hallucinations, or behavior changes. When you’re prescribed a stimulant, it is essential that you take your medication exactly as it is prescribed and your healthcare provider monitors you for side effects like increased heart rate, elevated blood pressure, insomnia, and anxiety, according to Sheridan. 

Can stimulants such as Adderall cause depression?

One potential side effect of stimulant drug use is changes in mood, which can include feelings of depression. If you are prescribed Adderall or another stimulant and you experience a worsening of your symptoms of depression, contact your healthcare provider. If you experience suicidal thoughts, call 911 or the Suicide and Crisis Lifeline at 988.

Bottom line: Work with your provider for the best treatment

The goal of a treatment plan for depression is to achieve remission—that is, the goal is to improve your quality of life and help you function normally. 

Research suggests that a combination of psychotherapy and antidepressant medication is more effective than either treatment by itself. The specifics of the combination can and do vary from person to person. You may do well on an SSRI, or an SNRI may work better for you. Some people also experience success with an atypical antidepressant medication such as bupropion, mirtazapine, or trazodone–and some people even take them along with an SSRI or SNRI.

Similarly, whether a stimulant such as Adderall can help you if you are living with depression is a question that you and your healthcare provider will have to discuss based on your specific situation.

“It is essential for patients to be honest about their medical history,” Sheridan says. “If I were approached by a potential patient to treat their depression with Adderall, we would need to fully explore their history, determine their goals, and come up with a plan together.” 

Ultimately, the most effective treatment for depression is one that will reduce the symptoms of sadness, hopelessness, and fatigue and help you regain a better quality of life. For some people, the treatment may include stimulants, but for most people with mild to moderate depression, the most likely approach will be some type of psychotherapy, such as cognitive behavioral therapy, an antidepressant medication, or a combination of both.