The prevalence of clinically diagnosed ADHD is increasing in most developed countries. For instance, among children and adolescents in the US it increased from 6.1% in 1997–1998 to 10.2% in 2015–2016. As a result, ADHD medication is one of the most commonly prescribed medication classes in child and adolescent psychiatry, and its use is increasing rapidly in adult psychiatry [1].
Concerta and Adderall are both widely used medications for Attention Deficit Hyperactivity Disorder (ADHD). Concerta is the brand name for its active ingredient methylphenidate. Adderall is the brand name for its active ingredient mixed amphetamine salts. Both medications are stimulants.
They differ in how they release their active ingredients. Concerta is an extended-release medication, releasing the drug slowly over time, and is usually taken once a day. Adderall comes in both immediate-release and extended-release forms, with effects appearing quicker and often shorter in duration.
In this article, I describe the common and less-common side effects that are important to know if you are taking either medication. Both have risk of substance abuse, although Adderall more so.
How Do Concerta and Adderall Work?
Both medications increase levels in the brain of the neurotransmitters norepinephrine and dopamine. Dopamine is involved with feeling pleasure and motivation. Norepinephrine helps executive functions involved with staying awake, thinking clearly, and paying attention [2] [3]. But they work in different ways, which explains why they have different side effects and risk profiles.
Concerta (Methylphenidate) is mainly a reuptake inhibitor. It blocks the reabsorption of dopamine and norepinephrine, allowing them to remain active in the brain for longer.
Adderall (Amphetamines) is a releasing agent. It not only blocks reuptake but also forces the neurons to release more dopamine and norepinephrine into the synapse.
Shared Risks and Side Effects of Concerta and Adderall
As central nervous system stimulants, both medications share similar adverse risks. These can vary depending on age and other health conditions [2] [3]:
- Decreased or loss of appetite
- Trouble sleeping
- Nausea and vomiting
- Upset stomach and stomach pain
- Weight loss
- Anxiety
- Dizziness
- Feeling irritable or easily annoyed
- Mood swings and restlessness
- Fast heartbeat or a feeling of skipped heartbeats (see below)
- Increased blood pressure (see below)
- Headache
- Dry mouth
- Diarrhea
- Excessive sweating
- Feeling tired
- Dependence and tolerance (more prevalent with Adderall)
There is also the potential for a rebound effect as the medication wears off, leading to fatigue, low mood, and irritability.
In addition, Adderall has some other side effects [4]:
- Weakness
- Constipation
- Less interest in sex
- Unusual sense of well-being
- Difficulty keeping an erection
- Twitching
- Adderall can also slow a child’s growth.
Serious Side Effects of Concerta and Adderall
Although generally rare, there is a range of serious side effects of both medications [2] [5] [6]:
Cardiovascular Risks
Both medications carry a black box warning from the FDA regarding the risk of sudden death in patients with pre-existing serious heart problems. They can increase blood pressure and heart rate, and affect blood flow, requiring monitoring. A thorough cardiac evaluation is essential before starting either medication.
Psychiatric Risks
Although rare at therapeutic doses, both can cause depression, psychosis, mania (moments of extremely high excitement and energy), aggression, delusions (false beliefs), and hallucinations (seeing something that’s not really there).
One study suggests Adderall may have a 5-fold higher potential for inducing psychosis and paranoia, especially at higher doses or in susceptible individuals [5]. Concerta is often associated with a higher incidence of anxiety and nervousness.
Risk of Misuse, Addiction, and Diversion
Both medications are classified as Schedule II controlled substances due to a high potential for abuse. Due to its mechanism of action (forcing neurotransmitter release), Adderall is generally considered to have a higher potential for misuse and addiction compared to Concerta. It is more sought-after as a “study drug” and for recreational use, leading to a greater risk of diversion.
Long-Term Effects and Growth Suppression
A well-documented risk in children is a temporary suppression of growth in height and weight. This is a risk with both medications and requires careful monitoring by a pediatrician.
Other Risks
Other more serious side effects of Concerta include [6]:
- Sexual side effects, such as priapism (painful, persistent erection)
- Seizures
- Vision changes
- Reduced growth in children
- Severe allergic reaction
Other more serious side effects of Adderall include [7]:
- Uncontrollable shaking, tics, or seizures
- Eyesight changes or blurred vision
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Sources
[1] Chang, Z., et al. (2019). Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases. Biological psychiatry, 86(5), 335–343.
[2] Ishver A. 2024. Methylphenidate (Concerta, Ritalin, and others) – Uses, Side Effects, and More. WebMd.com.
[3] Mitri Williamson J. 2022. Concerta (methylphenidate). MedicalNewsToday.com.
[4] [Cristol H and K. Whitbourne. 2024. Adderall Side Effects. WebMd.com.
[5] The Harvard Gazette. 2024. High doses of Adderall may increase psychosis risk.
[6] Weiss D. 2025. Side Effects of Concerta: What You Need to Know Healthline.com
[7] Hobbs H. 2024. The Effects of Adderall on the Body. Healthline.com.