Ritalin and Other Methylphenidates

What Kind of Drug Is It?

Ritalin and other methylphenidates belong to a class of drugs called stimulants, which typically excite or speed up the brain and body. Stimulants increase endurance, reduce hunger, make the user feel less tired, and produce feelings of well-being and happiness. Many substances, both legal and illegal, are considered stimulants. Caffeine is a mild stimulant found naturally in coffee, tea, and chocolate. Amphetamines (am-FETT-uh-meens) are powerful stimulant drugs available only by prescription. Methylphenidates are chemically related to amphetamines, but their effects are not as intense. They, too, are available only by prescription. Cocaine and crack are examples of illegal stimulants. (Entries on caffeine, amphetamines, and cocaine are also available in this encyclopedia.)

Methylphenidates, such as Ritalin, are primarily prescribed to treat attention-deficit/hyperactivity disorder (ADHD). People with ADHD usually have difficulty focusing and controlling their actions. For example, they might speak or act rashly before thinking about the consequences of such behavior. The main symptom of ADHD is hyperactivity, which means that an individual is noticeably more active than his or her peers. Children with ADHD often have trouble paying attention in school, sitting still, and waiting their turn. They may have difficulty concentrating or focusing on certain tasks, including tests and assignments. These difficulties sometimes interfere with social development and building lasting relationships.

ADHD is frequently diagnosed in childhood, but it can continue into adulthood. As such, it really affects individuals of all ages. Methylphenidate can help ADHD sufferers even though it is a stimulant. It does not produce a stimulant effect in people diagnosed with ADHD. Instead, it works by helping the user's brain filter out distractions, thus improving his or her ability to focus on a given task.

Official Drug Name: Methylphenidate (METH-uhl-FENN-ih-date), methylphenidate hydrochloride, Ritalin, Ritalin SR, Concerta, Metadate CD, Metadate ER, Methylin, Methylin ER; dexmethylphenidate (DEKS-meth-uhl-FENN-ih-date; Focalin)

Also Known As: Vitamin R, West Coast, R-ball

Drug Classifications: Schedule II, stimulant

Narcolepsy and Depression

Methylphenidate is also used to treat narcolepsy, a disorder that causes people to become sleepy during the daytime and experience uncontrollable episodes of sleep. In narcoleptic patients, the stimulating effects of the drug help to control daytime drowsiness. Physicians sometimes prescribe methylphenidate for other purposes, such as enhancing the effects of antidepressants in people suffering from severe depression. In these cases, doses are typically lower than doses used in the treatment of ADHD.

Overview

Methylphenidate is one of the most commonly prescribed medications for the treatment of ADHD. Ritalin is among the most frequently prescribed brands of methylphenidate and is probably the most familiar medication for ADHD. Other methylphenidate brand names include Concerta and Metadate. There are also generic (non-brand name) forms of the drug. A related medicine, dexmethylphenidate, is sold under the brand name Focalin.

Methylphenidate was patented in 1950 by the CIBA Pharmaceutical Company, a Swiss company that later became part of Novartis. A global pharmaceutical company, Novartis is the maker of Ritalin. In 1955 the U.S. Food and Drug Administration (FDA) approved methylphenidate for various psychological disorders. A 2004 article on methylphenidate in the Journal of Child and Adolescent Psychiatric Nursing noted that treating children who have ADHD with stimulants such as methylphenidate and amphetamines is 80 to 90 percent effective. Methylphenidate treatment can decrease symptoms by 50 percent in some patients.

Abuse of Ritalin and Other Methylphenidates

Some people take Ritalin and other methylphenidates without a prescription for nonmedical purposes. High school and college students have been known to take the drug to stay awake and increase their attention span when studying. The drug is also used recreationally in combination with alcohol. "Recreational" refers to using drugs solely to get high, not to treat a medical condition. Alcohol is a depressant and drinking too much of it slows people down and makes them feel tired. So some people combine methylphenidate and alcohol because it allows them to stay awake and interact with others while continuing to drink. Other abusers mix Ritalin with heroin, cocaine, or both for a stronger stimulating effect. The abuse of methylphenidate, with or without other substances in the mix, can cause serious psychological and physical harm to the user.

How the Knowledge of ADHD Evolved

Attention-deficit/hyperactivity disorder was first described in print in an 1845 children's book written by Dr. Heinrich Hoffman. The author wrote scholarly articles on psychiatry, as well as poems and books for young people. One of his most famous children's books, written for his three-year-old son, was The Story of Fidgety Philip. The story's main character is a young boy who displays ADHD-like symptoms.

ADHD was officially recognized in 1902, when British scientist George F. Still published a series of lectures. The lectures described children with behavioral problems. Many of these problems were caused by the fact that the children were easily distracted and acted very impulsively. Dr. Still thought that the children's problems were biological and not related to how they were raised. Their symptoms matched the definition of ADHD in 2005.

In the 1950s, children with ADHD were labeled as having "minimal brain dysfunction." This rather clinical term suggested that the children's brains were not working properly. However, it failed to describe their condition correctly. After further study, researchers learned the causes and symptoms of the disorder were quite complex.

In 1968, a paper on a disorder resembling ADHD was issued in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. The name given to the disorder was "hyperkinetic reaction of childhood." Hyperkinetic means having an unusually high or uncontrollable activity level. Symptoms of the condition included: a short attention span, excessive fidgeting, and general restlessness. The disorder was given different names over the years, but medical professionals eventually settled on the term "attention-deficit/hyperactivity disorder (ADHD)." Another common name still used in the United States and many parts of the world is attention deficit disorder (ADD).

Who Has ADHD

ADHD affects both males and females of all races and ethnicities. It is one of the most commonly diagnosed mental disorders in children and adolescents. In May of 2000, Terrance Woodworth, then-deputy director of the Office of Diversion Control at the U.S. Drug Enforcement Administration (DEA), testified before Congress on Ritalin use. He noted that about 80 percent of the prescriptions written for the two major drugs used to treat ADHD (methylphenidate and amphetamine) were for children. Woodworth also noted that between 1991 and 1999, U.S. sales of methylphenidate increased by nearly 500 percent. And that trend has continued. According to the article "ADHD Drugs Move into the Workplace" on MSNBC.com, "U.S. retail sales of the total ADHD drug market more than tripled between 2000 and 2004."

Who has ADHD is a matter of debate. Many studies indicate that the condition occurs much more frequently in boys. However, some believe that this is no longer the case. The organization Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) released a fact sheet titled "Evidence-Based Medication Management for Children and Adolescents with ADHD." According to that fact sheet, "recent research shows that the … numbers [of boys and girls with ADHD] may be nearly equal." In all, about 3 to 7 percent of the school-age population in the United States has ADHD.

In a study conducted by researchers at the Mayo Clinic, however, more boys were found to have ADHD than girls. But the study also indicated that parents' education plays a role. "Our [study's] results confirm that male sex and low parental education significantly increase ADHD risk," according to researcher Jennifer St. Sauver, as quoted on CBS News. In the report, issued in 2002, the scientists commented on their findings about the parents in their study sample. "Less educated parents may have less effective parenting styles and may provide a less structured environment" that could cause the ADHD to intensify. Plus, it's possible that the parents had difficulty in school themselves because they had ADHD as well.

ADHD begins during the preschool years, and it is usually diagnosed by the time a child is in kindergarten or early elementary school. However, the disorder continues into adulthood, and sometimes it is not even diagnosed until later in life. Although the exact causes of ADHD are unknown, research indicates that it runs in families, meaning it is an inherited condition. According to the CHADD fact sheet, "problems in parenting or life situations may make ADHD better or worse, but they do not cause the disorder."

Diagnosing ADHD

ADHD is a condition that becomes apparent in some children in the preschool and early school years. It is hard for these children to control their behavior, pay attention to a teacher, or focus on an assignment. People with ADHD may be fidgety, forgetful, and do impulsive things. They often interrupt conversations and act without thinking about the consequences. These behaviors can interfere with social interactions and school performance. But not everyone who displays symptoms of ADHD has the disorder. Being very talkative and showing signs of inattention are traits that exist in many children and adults, but at a low level or over a short period of time.

The Positive Side of ADHD

ADHD is often seen in a negative light. Teachers might view ADHD kids as students who are disruptive or act in a confrontational manner. Adults and children sometimes think that those who have the disorder lack intelligence. But this is usually not the case. ADHD affects people in a wide variety of ways. Although it is generally agreed that the symptoms of ADHD can cause problems for children and adults, especially in work and school settings, some researchers have talked about the benefits of having the disorder.

According to these researchers, the benefits of ADHD include creativity, energy, and a willingness to take risks. ADHD can also cause a person to combine ideas in new ways and think "outside the box." Consider kids in an elementary or middle school science class. A psychologist at Santa Clara University, Dr. Lara Honos-Webb, was quoted in a 2005 Newsweek article as saying, "While the A students are learning the details of photosynthesis, the ADHD kids are staring out the window and wondering if it still works on a cloudy day."

ADHD support groups note that many imaginative people displayed classic ADHD behaviors, such as impulsivity, inattention, and disorganized lives. The group called One ADD Place provides information and support for people with the disorder. They cite American inventor Thomas Edison (1847–1931), German-born American physicist Albert Einstein (1879–1955), British politician Winston Churchill (1874–1965), and British mystery writer Agatha Christie (1890–1976) as being among those who have exhibited ADHD-like symptoms. A2005 Wall Street Journal Online article told the story of the chief executive officer (CEO) of JetBlue Airways—someone who never took drugs for his ADHD. He believes the disorder helped him succeed in the business world and even contributed to his invention of the electronic airline ticket. E-tickets are helpful for people who are forgetful, like those with ADHD.

Diagnosing ADHD is a complex process. The symptoms of ADHD must continue for at least six months, and the behaviors must create a real handicap in at least two areas of a person's life. These areas include academic, social, and family aspects of life. An individual who shows some symptoms of ADHD, for example, but whose schoolwork and friendships are not harmed by these behaviors, would not be diagnosed with the disorder.

Prescriptions Increase

By 1975, more than 1 million U.S. children had been diagnosed with ADHD, according to "The Top Pharmaceuticals That Changed the World: Ritalin," a 2005 article in Chemical & Engineering News. About 500,000 of those patients were being treated with drugs, the article stated, with more than half of them receiving Ritalin. In the mid-1990s, ADHD diagnoses nearly doubled to 2 million. In a 2000 article in USA Today, the American Academy of Pediatrics put the number of students with ADD/ADHD at nearly 4 million. Mayo Clinic researchers announced in 2002 "that 7.5 percent of children up to the age of 19 have ADHD," according to CBS News. A 2003 booklet titled "Attention Deficit Hyperactivity Disorder," released by the National Institute of Mental Health, noted that 80 percent of children medicated for ADHD will still need the medication as teenagers. Half of those teens will continue on medication as adults. "The kids of the ADHD drug boom are growing up, and some are finding that what they thought would be a school-age ailment may in fact last a lifetime," noted MSNBC.com in May 2005.

Many studies have found that the number of children using ADHD medication differs depending on where the children live. For example, a 2003 study published in Pediatrics found that among commercially insured U.S. children, those living in the Midwest, compared with those in the West, were 1.55 times more likely to use at least one stimulant medication. Those living in the South were 1.71 times more likely that those in the West to do the same. In the study, about 65 percent of all stimulants used were methylphenidates. Many factors could play a part in this regional variation, including different state laws on illegal use of substances, drug advertising, physician style, and expectations of parents and teachers in the community.

In the 2000 article "Just Say Yes to Ritalin!: Parents Are Being Pressured by Schools to Medicate Their Kids—Or Else," Dr. Lawrence H. Diller noted that some "4 million children [are] taking Ritalin in America." He also explained that some doctors think that Ritalin is being overprescribed for some and underprescribed for others. "Data shows, for example, that African-American families use Ritalin at rates one-half to one-quarter of their white socioeconomic peers. Asian-American youth are virtually absent in statistics for Ritalin use."

Overdiagnosis of ADHD?

A dramatic increase in the number of both children and adults being diagnosed with ADHD has prompted controversy. Some parent and health groups say that doctors are overdiagnosing ADHD, especially among children. The result of overdiagnosing, they say, is that children may be taking unnecessary drugs, which can lead them to experience unnecessary side effects.

In some cases, the concern is that methylphenidates (and other ADHD drugs) are being prescribed to control "problem" children so that they will not disrupt class or home life. Other concerns are that naturally energetic and imaginative children are being labeled as having ADHD because these characteristics and the symptoms of the disorder are similar. Psychologist Deborah Ruf told Colette Bouchez of WebMD Health that "an alarming number of children who are simply creative, gifted individuals are mistakenly being diagnosed with ADHD." Many health organizations, however, say the growth of ADHD cases suggests that the disorder is better understood, more easily recognized, and more generally accepted within the medical communities. They also defend a parent's right to seek drug therapy for ADHD children.

Parents Pressured to Medicate

Some parents and their children believe that taking medications, such as Ritalin, are unnecessary, and they refuse to participate in what they call the "drugging" of America's children. They are concerned about the side effects of ADHD drugs and the fact that the long-term effects are still unknown. Anti-Ritalin groups contend that such drugs interfere with a child's personality and creativity. However, some teachers find it difficult to manage students who have ADHD and aren't taking any medication. They believe that ADHD drugs will benefit children who are too disruptive in class. Some schools have told parents that their children need to be evaluated to see if they would benefit from taking ADHD drugs.

FDA Announces Plans to Study Concerta

In mid-2005, the FDA announced that it would consider placing new warnings on Concerta and other methylphenidates. Concerta is a long-lasting form of Ritalin. "The FDA has identified two possible safety concerns with the methylphenidate drug products: psychiatric adverse events and cardiovascular adverse events," noted the FDA in a statement.

Specifically, the FDA decided to look into reports that some children on ADHD drugs have experienced hallucinations, suicidal thoughts, episodes of violent behavior, and increased aggression. NBC4.TV quoted Dr. Dianne Murphy of the FDA as saying: "Some kids saw bugs—took them off the drug, the bugs went away." She added: "Put them back on the drug, the bugs came back."

USA Today explained that the FDA will also look into reports that the drugs can cause "high blood pressure, arrhythmia and racing heartbeats." CNN.com noted that the FDA will study the drugs because "[t]he FDA can't say if the drugs actually cause those side effects—the reports are from a database of reactions reported by medication users." It's not yet clear if the side effects are caused by the ADHD drugs or can be attributed to some other factor.

A number of parents have refused, only to be told by school staff that their children are just too hard to handle. They are advised to "Medicate or Else!," according to Diller. He added that such schools "will not allow students to attend [regular] classes unless they are medicated." Some parents have had to make that choice—put their children on medication or put them in special education classes. Some parents relunctantly agree and have their children put on ADHD drugs. Others fight the schools and even file lawsuits against what they call "legal drug pushing."

A small percentage of parents have pulled their children out of public schools to homeschool them instead. In "Teaching Children Well, from Home" on MSNBC.com, a mother described her frustration with her daughter's educational experience in public schools. Rather than place her child in special education, the mother decided to homeschool her daughter. "Three years later, she's off Ritalin and working above her grade in many subjects," noted the authors of the article. Homeschooling is believed to help some ADHD sufferers because they receive more individual attention in a more structured setting.

Parents who don't want to medicate their children have also been subjected to legal trouble. "In the most extreme cases," noted Diller, "parents unwilling to give their kids drugs are being reported by their schools to local offices of Child Protective Services, the implication being that by withholding drugs, the parents are guilty of neglect[ing their children]." According to USA Today, "some parents are medicating their children for fear of having them hauled away." Parents have also been pressured to medicate their children by neighbors and relatives. In some situations, divorcing parents disagree on whether their child should be medicated, so the decision falls to a judge.

Taking the Stand Against Ritalin

Various groups of parents and other concerned individuals believe that ADHD medicines are greatly overused in the United States. Testifying before Congress in 2002, Lisa Marie Presley of the Citizens Commission on Human Rights stated: "I find it alarming that in my 13 years of motherhood, the use of Ritalin for ADHD has increased 700 percent. Today it is estimated that between six and eight million American children take psychiatric drugs for ADHD and other so-called learning and behavioral disorders." Urging Congress to look into finding drug-free alternatives, she described the situation as "the totally needless and tragic drugging of innocent children."

Methylphenidate and Narcolepsy

Methylphenidate is also used to treat narcolepsy, a life-long sleep disorder. Although the disorder can affect people of any age, in most cases the symptoms are first noticed in teenagers and young adults. However, it is not uncommon for there to be a delay of ten years between the onset of the symptoms and a final diagnosis.

Narcolepsy was first described in 1880 by a French physician who gave the disorder its name. The name comes from two Greek words: narke, meaning "to numb," and lepsis, meaning "seizure." People who have narcolepsy are frequently drowsy and can fall asleep suddenly and deeply, often in the middle of an activity. The effects of this disorder can cause serious problems. People may fall asleep at work or school, while having a conversation, playing a game, eating a meal, or even driving a car. Orphan Medical, Inc., the maker of a new non-methylphenidate narcolepsy drug called Xyrem (ZY-rem), reported in 2005 that narcolepsy affects about 100,000 to 140,000 Americans, but only 50,000 of these individuals receive treatment for their symptoms.

What Is It Made Of?

Methylphenidate is a synthetic substance that is chemically related to amphetamines. Synthetic substances are produced in a laboratory from chemicals. Methylphenidate is also related to the substance piperidine, a chemical used in the manufacture of rubber. Methylphenidate is a white, odorless, fine crystalline powder with a chemical structure similar to that of the neurotransmitter called dopamine.

How Is It Taken?

Methylphenidate comes in tablet, liquid, and capsule form. When used for medical purposes, it is taken by mouth. The FDA has approved methylphenidate for patients six years of age and older, but it is sometimes prescribed for children younger than six.

Illegal users of the drug usually swallow it, inhale or snort it through the nose, smoke it, or inject it by needle into a vein. Abusers typically crush the tablets into a powder to inhale or smoke the drug. To prevent abuse, some methylphenidate tablets—Concerta, for example—are made in a special way so they cannot be ground into a powder. To inject the drug, abusers usually dissolve immediate-release methylphenidate tablets in water and then inject the mixture into a vein with a needle and syringe.

Methylphenidate Formulas

Methylphenidate is available as an immediate-release tablet and liquid; an intermediate-acting (extended-release) tablet; and a long-acting (extended-release) capsule and tablet. Some of the tablets are chewable. Immediate-acting formulas have an effect that lasts approximately three to four hours; intermediate-acting formulas last about six to eight hours; and long-acting formulas last approximately eight to twelve hours. The immediate-release formulas are typically taken two to three times a day. Dexmethylphenidate (Focalin) is an immediate-release tablet that is usually taken twice a day. Ritalin and Methylin are methylphenidates that are taken two or three times a day. Longer-acting versions of the drug (such as Concerta) are becoming more popular, however. According to the CHADD fact sheet, these formulas "may cause fewer 'ups and downs' over the day and may eliminate the need for taking additional doses at school or during work."

When a person takes an extended-release formula, part of the drug is released into the body shortly after it is swallowed, while the remaining drug in the capsule or pill is released more slowly. Different extended-release formulas use different methods to deliver the medicine into the body over many hours. Packing the methylphenidate into granules called beads is one method. Metadate CD capsules use this bead-delivery system. These capsules use two different types of beads. The rapid-release beads allow the medicine to reach the bloodstream quickly. In Metadate CD, about 30 percent of the drug is released immediately. The extended-release beads, which make up the remaining 70 percent of the capsule, dissolve slowly over several hours. Ritalin LA uses the same bead delivery system, but it contains about 50 percent rapid-release beads.

Concerta is an extended-release formula of methylphenidate that uses a different method to release its medicine. The tablet has an outer methylphenidate coating that dissolves immediately when swallowed. Once that drug dissolves, an underlying membrane allows water to flow in and out of the tablet. Beneath the membrane are two more layers of drug. When water enters the tablet, it expands and pushes the drug out of the top. The delivery time can be increased by using a thicker membrane or decreased by using a thinner one.

Methylphenidate Dosages

The dose of Ritalin and other methylphenidate formulas depends on the age and size of the patient and the nature and severity of the medical disorder. The starting dose of the immediate-acting formula of methylphenidate for adults and teenagers with either ADHD or narcolepsy is generally between 5 and 20 milligrams, taken two or three times a day. The medicine can be taken with or after meals. Younger children with ADHD generally start at 5 milligrams and take the drug two times a day. Chewable tablets should be thoroughly chewed and taken with a full glass (eight ounces) of water or other liquid.

For extended-release formulas, the recommended starting dose is 20 milligrams a day for adults, teenagers, and children over six years old. The maximum dose is generally 60 milligrams per day. The medicine is taken in the morning before breakfast. Intermediateacting and long-acting extended-release tablets and capsules are designed to be swallowed whole.

Are There Any Medical Reasons for Taking This Substance?

Ritalin and other methylphenidates are approved by the FDA to treat ADHD and narcolepsy. In some cases, methylphenidate is used in the treatment of other medical disorders, such as symptoms associated with a traumatic brain injury. Such injuries can be caused by a blow to the head, a fall, or a car crash. People who experience

traumatic brain injury often experience behavioral problems and ADHD-like symptoms, including decreased attention span. These symptoms can last for years after a moderate or severe brain injury. Methylphenidate has also been used to help patients who have suffered a stroke and to enhance the effects of antidepressants.

Most methylphenidate prescriptions are written for children with ADHD. Methylphenidate helps children and adults with ADHD to increase their focusing abilities and decrease their level of distraction. Experts agree that drugs alone are not the best treatment for people with ADHD. Psychological and behavioral therapies, as well as behavior modification—in combination with medicines—offer the most effective means of dealing with the symptoms of ADHD.

Usage Trends

Both legal and illegal uses of prescription medications have increased significantly since the 1990s, especially in the United States. A 2005 report by the Partnership for a Drug-Free America states that 10 percent of American teenagers (2.3 million young people) admit to using the prescription drug Ritalin or Adderall without a doctor's order. (Adderall is an amphetamine-type drug used to treat ADHD. An entry on Adderall is included in this encyclopedia.)

The illegal use of Ritalin and other methylphenidates among high school and college students began to rise in the late 1990s. Students used the drug at parties, often snorting it to get a quick high. By the early 2000s, reports were surfacing of high school and college students using Ritalin for academic purposes. Users claim the drug helps them stay awake and focus during late-night study sessions or while writing essays. In a 2005 article for USA Today, Donna Leinwand wrote that students who take stimulants such as Ritalin are doing so "not necessarily to get high, but also to ease stress or to try to improve academic performance." The article further noted that universities with high academic standards tend to have higher rates of illegal prescription drug use.

Some students abuse prescription drugs like Adderall or Ritalin because they want to perform better on tests, such as college entrance exams. Students feel a lot of pressure to succeed, and some believe using these prescription drugs, even illegally, will help them focus and get better scores. They defend their drug abuse by claiming that a low test score can mean many missed opportunities and lesser job opportunities. Other students believe that using performance-enhancing drugs is unfair and is a form of cheating.

What the Surveys Say

Data collected on methylphenidate use for the "2003 National Survey on Drug Use and Health" show that nonprescription use of the drug has held steady since 2000. The highest percentage of use is in the eighteen- to twenty-five-year-old age group (5.7 percent).

Monitoring the Future (MTF), an annual survey that tracks drug use among eighth, tenth, and twelfth graders, revealed a similar trend. MTF is conducted by the University of Michigan and funded by the National Institute on Drug Abuse (NIDA). The survey began including questions about Ritalin in 2001. The 2004 survey noted that 2.5 percent of eighth graders, 3.4 percent of tenth graders, and 5.1 percent of twelfth graders had taken Ritalin without a prescription.

How Users Get Ritalin

Some drugs of abuse can be manufactured illegally. This is not true for methylphenidate. The four ways users can obtain Ritalin and other methylphenidates are: 1) from a doctor; 2) from a pharmacy; 3) from someone else who has a prescription for it; or 4) from a drug dealer who has obtained it through illegal means. Methods of getting methylphenidate illegally include stealing, drug trafficking, and faking prescriptions.

Effects on the Body

The effect of methylphenidate on the user depends on the amount of drug used and the way it is taken. Researchers are studying possible long-term effects of the misuse and long-term use of methylphenidate on a person's brain and behavior.

The Role of Neurotransmitters

Methylphenidates increase the levels of a natural substance in the brain called dopamine. Dopamine is a neurotransmitter, a substance that helps nerve cells communicate with one another. Dopamine plays a critical role in motivation and feelings of pleasure. It is involved in naturally pleasurable activities such as eating good food and being sexually aroused. Methylphenidate is similar to other addictive drugs, such as cocaine and alcohol, in that they all increase dopamine levels.

Research published in the January 2001 issue of the Journal of Neuroscience found that relatively small amounts of methylphenidate increase dopamine levels in the brain. The study, led by Dr. Nora Volkow at the Brookhaven National Laboratory, used the same amounts of methylphenidate that are typically prescribed for children. Through brain-imaging techniques, the study found that men who took a dose of Ritalin an hour before the test had higher dopamine levels than those who did not. Dr. Volkow, a psychiatrist who became head of the National Institute on Drug Abuse (NIDA) in 2004, said in a press release that by increasing free dopamine levels, "you can activate … motivational circuits and make the tasks that children are performing seem much more exciting."

Concerns about Addiction

Both cocaine and methylphenidate increase dopamine levels in the brain. Cocaine is a very addictive drug, but methylphenidate is generally not addictive when taken by prescription at the recommended dosage. Oral doses of methylphenidate take about sixty minutes to reach the brain. This length of time prevents the drug from causing the kind of high produced by many illicit, or illegal, drugs that release dopamine. When snorted or injected, however, methylphenidate has the potential to be addictive. In both of these methods, the drug reaches the brain more rapidly than when swallowed in pill form.

The most frequently observed side effects of Ritalin and other methylphenidates (when used appropriately) are difficulty sleeping, loss of appetite, and nervousness. Less common side effects include skin rash, fever, weight loss, dizziness, headaches, stomach pain, irregular heartbeat, difficulty breathing, and feelings of anxiety. It is possible that long-term use of methylphenidate causes slowed growth in children.

Some parents fear that children who take methylphenidate in childhood may become substance abusers in their teens. They note that ADHD drugs such as Ritalin are listed as Schedule II stimulants, which is the same designation used for cocaine. In her testimony to Congress in 2002, Presley noted: "Suicide is the major complication of withdrawal from Ritalin and similar drugs." On its Web site, the Citizens Commission for Human Rights features various stories of young adults who have turned to harder, illegal drugs allegedly as a result of taking prescribed ADHD drugs in childhood.

However, CHADD's "Evidence-Based Medication Management for Children and Adolescents with ADHD" presents a different perspective. Researchers concluded that the proper use of stimulant medicines did not increase a person's risk for later substance abuse. They suggest that when children with ADHD receive the appropriate drug treatment, their risk of later drug or alcohol problems is about the same as that of any other non-ADHD individual.

Schedule II Drugs

Some parents and children are concerned about drugs such as Ritalin because they are listed as Schedule II stimulants. Schedule II drugs are those that have a high potential for addiction, but have accepted medical uses. Parents worry that their children will become addicted to these drugs and might want to try more dangerous drugs later in life.

Methylphenidate Used to Get High

The health consequences of methylphenidate abuse depend on the method used to deliver the drug into the body. When injected, the drug moves quickly into the body and bypasses many of the body's natural defenses against environmental contaminants. Dust, bacteria, or other substances can get into the solution and cause serious harm to the user. Users who inject methylphenidate risk health problems like blood clots, infections, and drug overdoses. Those who share needles increase their chances of contracting hepatitis, a liver disease, and HIV (the human immunodeficiency virus), which can lead to AIDS (acquired immunodeficiency syndrome). Snorting methylphenidate can seriously damage a user's nasal passages, causing open sores in the nose, frequent nose bleeds, and a burning sensation in the nose.

The abuse of methylphenidate can lead to a number of more general health problems, as well. Methylphenidate that is abused gives the user a high, which is addictive and leads to the desire for greater amounts of the drug. Higher doses can bring on agitation, uncontrollable shaking, and high blood pressure. Methylphenidate abusers may also see things that are not real, have strange ideas that are not true, and act in a bizarre manner. Severe consequences, including death, have been reported.

Reactions with Other Drugs or Substances

Ritalin and other methylphenidates are stimulants that activate the nervous system. The stimulating effects of methylphenidate increase significantly when the drug is used along with other stimulants such as caffeine or over-the-counter cold remedies. (An entry on over-the-counter drugs is included in this encyclopedia.) Methylphenidate can also cause complications if mixed with medications for high blood pressure, seizures, anxiety, or depression.

Treatment for Habitual Users

dependence on Ritalin and other methylphenidates can lead to withdrawal once the drug is stopped. Withdrawal is the process of gradually cutting back on the amount of a drug being taken until it can be discontinued entirely. Withdrawal can cause a variety of side effects, including depression, unusual behavior, and feelings of weakness and sleepiness. Users who stop taking methylphenidates should have their doses tapered down slowly under the direction of a physician.

The most effective treatment for methylphenidate abusers is behavioral therapy, sometimes used in conjunction with antidepressants. One behavioral approach is cognitive-behavioral therapy (or talk therapy), which focuses on modifying the patient's attitudes, thinking processes, and coping skills. Recovery support groups may also be helpful, especially in the months or years following addiction treatment.

Consequences

Patients who have epilepsy or other seizure disorders (sudden attacks of involuntary muscle movement) could increase their risk of having seizures if they take methylphenidate. Methylphenidate may worsen symptoms in people who experience tics. Methylphenidate can also cause serious problems when taken by people with severe anxiety or high blood pressure. When a patient first starts taking the drug or restarts it after going without it for a month or more, the medication has a more pronounced effect.

Individuals who abuse methylphenidate or patients who have developed a dependence on the drug may experience an increased tolerance to the drug. When this happens, higher and higher doses of a drug are needed to produce the original effect (or high) experienced. These individuals may also experience a psychological dependence on the drug. This means that, over time, the frequent user will begin to feel that he or she needs the drug to function effectively.

The Law

Methylphenidate is a strictly regulated drug and is available only with a prescription. Its use is controlled by federal law. The U.S. Controlled Substances Act (CSA) of 1970 places all controlled drugs into one of five categories called schedules. These schedules are based on a substance's medical value, harmfulness, and potential for abuse and addiction. Schedule I is reserved for the most dangerous drugs that have no recognized medical use.

Methylphenidates like Ritalin are categorized as Schedule II drugs with genuine medical uses that also have a high potential for abuse and addiction. This is the most restrictive category for medical drugs. The U.S. government requires special licenses for the manufacture and distribution of methylphenidate. Possessing methylphenidate without a medical doctor's prescription is against the law and can result in imprisonment and heavy fines.

Whether parents should be forced to put their children on ADHD medications is still highly debated. Various lawsuits have been filed to determine whether schools can insist that hard-to-handle children be medicated. Also, parents continue to fight for laws to protect their rights not to medicate their children.

For More Information

Books

Degrandpre, Richard. Ritalin Nation: Rapid-Fire Culture and the Transformation of Human Consciousness. New York: W.W. Norton and Co., 2000.

Diller, Lawrence. Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill. New York: Bantam Books, 1999.

Hallowell, Edward M., and John J. Ratey. Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood. New York: Touchstone, 2004.

Hyde, Margaret O., and John F. Setaro. Drugs 101: An Overview for Teens. Brookfield, CT: Twenty-first Century Books, 2003.

Vidya Bhushan, Gupta. No Apologies for Ritalin. Oradell, NJ: Exceptional Parent Press, 2000.

Westcott, Patsy. Why Do People Take Drugs? New York: Raintree Steck-Vaughn Publishers, 2001.

Periodicals

Cox, E., and others. "Geographic Variation in the Prevalence of Stimulant Medication Use among Children 5 to 14 Years Old: Results from a Commercially Insured U.S. Sample." Pediatrics (February, 2003).

Henry, Celia. "Special Delivery." Chemical & Engineering News (September 18, 2000): p. 49.

Kluger, Jeffrey. "Medicating Young Minds." Time (November 3, 2003): p. 3.

Leinwand, Donna. "Prescription Abusers Not Just After a High." USA Today (May 25, 2005).

Scahill, Lawrence, Deirdre Carroll, and Kathleen Burke. "Methylphenidate: Mechanism of Action and Clinical Update." Journal of Child and Adolescent Psychiatric Nursing (April-June, 2004).

Thomas, Karen. "Parents Pressured to Put Kids on Ritalin." USA Today (August 8, 2000).

Tyre, Peg. "Finding What Works." Newsweek (April 25, 2005): p. 54.

Underwood, Anne. "The Gift of ADHD." Newsweek (March 14, 2005):p.48.

Volkow, Nora D., and others. "Therapeutic Doses of Oral Methylphenidate Significantly Increase Extracellular Dopamine in the Human Brain." Journal of Neuroscience (January 15, 2001).

Zamiska, Nicholas. "Pressed to Do Well on Admissions Tests, Students Take Drugs; Stimulants Prescribed for Attention Disorders Find New Unapproved Use." Wall Street Journal (November 8, 2004): p. A1.

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Zaslow, Jeffrey. "Those Afflicted with ADHD Are Often the Most Creative." Wall Street Journal Online. http://www.careerjournal.com/columnists/movingon/20050204-movingon.html (accessed August 20, 2005).

See also: Adderall; Amphetamines; Dextroamphetamine