How high can you go? Today, we look at the upper limits of stimulant dosing.

Welcome to the Carlet Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Sagan, the editor-in-chief of the Carlat Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

We're continuing our countdown of the most read articles from 2023, with number three on the list.

Stimulent Dosing Limits by Kelvin Quinonez, Lara-Quente, MD, PhD, and Chris Aiken, MD.

You can read all of the Top 15 articles free online through the link in the show notes,

or just Google Top 15 Carlet Psychiatry Articles of 2023.

Dr. Quinonez Laracuente is an assistant professor, the Department of Psychiatry at

NYU Grossman School of Medicine, and he wrote this piece in his final year of residency

at NYU, where Dr. Aiken taught a course on medical writing. He and Dr. Aiken have no disclosures

related to this material.

No disclosures this time, that is true, but the piece was inspired by a patient's scenario

that comes up with increasing frequency. We are seeing more and more adult patients come in

on high-dose stimulants. The floodgates opened up in 2004 when stimulants first got

approved for adult ADHD, a diagnosis that brings together two unfortunate forces in medicine.

On the one hand, the treatment is highly rewarding, a sought-after substance that has a long history of overuse in the U.S.

On the other hand, the diagnosis is difficult to make, requiring a childhood history that is

nearly impossible to pin down in adults, and requiring symptoms that show up in most other

psych disorders, or even in normal people who

are stressed out or sleep deprived. I don't have any research to back this up, but my guess is

that when stimulants are used to treat real ADHD, people respond well and they keep responding

...