As addressed in their article, this is known to occur (FDA data: 8.6%) but is only rarely reported in the medical literature (3). This may be due, in part, to the possibility that psychosis is highly likely to be recognized as an adverse event by clinicians (whether for FDA reporting or for the purposes of medical literature), but addiction is not—despite its more long-lasting, well-documented, and devastating personal and societal consequences. Moreover, be aware that ephedra products have been aggressively marketed as legal alternatives to illegal stimulants, with some ephedra products testing positive for controlled substances of abuse (4). Thus, these products are perhaps more likely to be consumed by those at risk of developing substance use disorders. Since our original case report was published in Psychosomatics(5), I have encountered two additional cases of ephedra dependence.