The Pros and Cons of Ritalin Use
ADHD is a mental disorder, usually diagnosed in childhood,
which manifests itself with symptoms such as hyperactivity,
forgetfulness, mood shifts, poor impulse control, and
distractibility.
Methylphenidate (MPH) is an amphetamine-like prescription
stimulant commonly used to treat ADHD in children and
adults. It is also one of the primary drugs used to treat
symptoms of traumatic brain injury and the daytime
drowsiness symptoms of narcolepsy and chronic fatigue
syndrome.
Brand names of drugs that contain methylphenidate include
Ritalin, Concerta, Metadate, Methylin, Rubifen and Focalin.
Methylphenidate's most notable side effect is migraines.
Migraines may appear hours after taking the drug.
Methylphenidate is a central nervous system (CNS) stimulant.
It is claimed to have a calming effect on many children who
have ADHD, reducing impulsive behavior and the tendency to
act out, and helps them concentrate on schoolwork and other
tasks.
Some researchers have theorized that ADHD is caused by a
dopamine imbalance in the brains of those affected. MPH is a
dopamine re-uptake inhibitor, which means that it increases
the level of the dopamine neurotransmitter in the brain by
partially blocking the transporters that remove it from the
synapses.
In the United States, methylphenidate is classified as a
Schedule II controlled substance, the designation used for
substances that have a recognized medical value but which
have a high potential for abuse because of their addictive
potential. Some people abuse MPH by crushing the tablets and
snorting them, the high resulting from the increased rate of
dopamine transporter blockade due to quicker absorption into
the bloodstream. In this manner, the effect of Ritalin is similar
to that of cocaine or amphetamine and such abuse can lead to
addiction. When taken orally in prescribed doses, MPH has a
low addiction liability and rarely produces a high.
Methylphenidate has been used illegally by students for whom
the drug has not been prescribed, to assist with coursework
and examinations.
Some consider the treatment of children with stimulant
medication to be controversial since the number of children
taking them has increased dramatically over the years.
However, criticism that methylphenidate is over-prescribed
may be unfounded; the incidence of ADHD is believed to be
between three and five percent of the population, while the
number of children in America taking Ritalin is estimated at one
to two percent.
Some have argued that prescription of stimulant medications
sets children up for future addictions. However, recent
research suggests that boys with ADHD who are treated with
stimulants like MPH are actually less likely to abuse drugs
including alcohol later in life.
As long-term use of methylphenidate was relatively uncommon
before the 1990s, the long-term neurological effects are not
well researched.
As documented for amphetamines, the potential of
methylphenidate use over many years causing permanent
neurological damage to dopaminergic systems exists at least
in theory.
Researchers have also looked into the role of methylphenidate
in affecting stature, with some studies finding slight decreases
in height acceleration. Other studies indicate height may
normalize by adolescence.
Both the United States Drug Enforcement Administration
(DEA) and the United Nations International Narcotics Control
Board have expressed concern about the ease with which
legally prescribed MPH is diverted to the illicit market.
According to the DEA, the increased use of this substance
[MPH] for the treatment of ADHD has paralleled an increase in
its abuse among adolescents and young adults who crush
these tablets and snort the powder to get high. Youngsters
have little difficulty obtaining methylphenidate from classmates
or friends who have been prescribed it.
At a Rhode Island middle school, half a dozen sixth graders
were charged with drug possession or distribution. Five
teenagers at a Florida high school faced similar charges.
With 11 million Ritalin prescriptions given out every year,
there's plenty circulating in what has become a schoolyard
black market. Many students who are prescribed the drug are
selling it to their peers for a few dollars a pill.
A recent study in Massachusetts found that of 3,500 high
school students, almost 13% admitted to using someone
else's Ritalin.
Ritalin, snorted or injected, is not only addictive, but can also
be deadly (can cause tremors, palpitations, hypertension,
convulsions).
The DEA is set to distribute a pamphlet to schools warning
about potential Ritalin abuse and recommending tight storage
and supervision to stem the problem.
Ritalin: Side Effects and an Alternative to Ritalin
It has been our opinion for years that Ritalin is a good
medication. But it can cause problems, sometimes serious side
effects, and must be used with caution.
Recent FDA warnings are starting to make us wonder about
recommending Ritalin these days. The evidence seems to be
mounting against it.
Our Clinical Director Dr. Cowan has worked with over 1,000
children and teens with ADHD over the past 20 years, and
hundreds of those ADHD patients were treated with Ritalin.
For about a third of those patients Ritalin made a "day and
night" difference. For another third Ritalin was "helpful." For
the rest, Ritalin either didn't help significantly, or it actually
caused problems. For a few ADHD kids there were significant
side effects ranging from loss of appetite, to seizures.
Most of the Ritalin side effect problems observed over the
years were due to physicians not being careful with the
prescriptions, and prescribing too much Ritalin per dose,
especially when first beginning treatment.
Other problems were observed when parents would continue
to give the Ritalin to their ADHD kid even when they saw that
the medication was causing the child problems. Ritalin is a
powerful tool and must be used carefully, if used at all.
Tip for Parents: The short-acting pill is better than the timed-
release pill. Also, the brand name "Ritalin" is much superior to
the generic "Methylphenidate." Always begin your "trial" of
medication with the real stuff. If that works, then feel free to
see if the generic will work as well as the "real stuff." Ritalin
begins to work in about 15 or 20 minutes. It peaks in
effectiveness at 1.5 to 2.5 hours, and lasts for about 3.5 to
4.0 hours.
More Ritalin Side Effects—
Some kids have "withdrawals" or a "trough
period" from coming off of the Ritalin dose
at about the 4 hour mark.
They may become irritable, tearful, emotional, or bratty. This
lasts for about 15 minutes, and tends to be worse with Ritalin
doses of 15 mg. or more.
The best remedy for this that we've found is a 12 oz.
Mountain Dew at about the 3.0 hour mark. The caffeine
"deflects" or "flattens out" the angle of withdrawal. This trick
works well.
We have seen hundreds of kids benefit greatly from Ritalin.
But doctors and parents must be observant and conservative.
We have also seen some horror stories with Ritalin. Start
slowly and cautiously. It is not a toy. And remember, there are
other things that you can do that work as well as Ritalin, and
are healthy for you!
Is Ritalin Dangerous?
Here is a link to a site that is strongly opposed to Ritalin
use, as the author, Mr. Lawrence Smith, states that his child
died as the result of its use.
He claims that there are about 20 deaths reported each year
to the FDA's MedWatch program from Ritalin. Although it is
hard to believe everything that is on the internet, I do think
that you should at least take a minute to look over his site
and consider the information.
Here is an email that Mr. Smith sent to me
in 2002:
Monday, February 25, 2002 9:35pm
Dear Webmaster,
My 14 year old son Matthew died from Ritalin use.
We were threatened by the school social worker that If we didn't comply
with their diagnosis and take him to the doctor and get him on some
Ritalin, that we could be charged with neglecting his educational and
emotional needs.
They explained ADHD as though it was a objective disorder. Well I have
sense done much research to find out that is a bunch of hog wash. I
have created the website www.ritalindeath.com to inform parents of the
truth behind ADHD.
With the horrible experience of losing my son from the medication Ritalin.
It has caused me to get to the bottom of it, and find out what the heck is
going on, and see what I can do to help other families from going through
the same hell we are now living.
My site tells our story in detail, with much information that I have
compiled. I hope that you will conceder putting my website on yours as a
link?
I feel that it is very important that parents get more information than
just a little selective information paid for by drug companies.
Sincerely,
Lawrence Smith
There are Other Choices—
Look at this chart comparing Ritalin to ATTEND and to EEG
Biofeedback treatment...
Ritalin is very effective. Ritalin works somewhat differently in
the brain than do the amphetamines like Dexedrine or
ADDerall. Ritalin seems to primarily impact on longer term
vesicular storage of Dopamine, while amphetamines primarily
impact the pool of newly synthesized Dopamine. It also has a
different effect on Norepinepherine.
Attend is also effective. It has amino acids, essential fatty
acids, phospholipids, homeopathic medicines, and more. It is
healthy and effective. And it does not require a prescription,
and comes with a no-risk trial policy second to none. It either
works - or it is free.
The main side effects of Ritalin that we have observed are loss
of appetite (feed a protein shake twice a day to help keep
weight up), some irritability or anger (as when you have had
too much caffeine), possible short term growth inhibition
(though long-term this may not be a problem). Remember,
every medication has possible bad side effects, so always
closely monitor your child when taking medications!
If there is a problem, don't give the next dose, and call your
doctor right away.
==> Are there any natural ways to treat ADHD?
ADHD is a mental disorder, usually diagnosed in childhood,
which manifests itself with symptoms such as hyperactivity,
forgetfulness, mood shifts, poor impulse control, and
distractibility.
Methylphenidate (MPH) is an amphetamine-like prescription
stimulant commonly used to treat ADHD in children and
adults. It is also one of the primary drugs used to treat
symptoms of traumatic brain injury and the daytime
drowsiness symptoms of narcolepsy and chronic fatigue
syndrome.
Brand names of drugs that contain methylphenidate include
Ritalin, Concerta, Metadate, Methylin, Rubifen and Focalin.
Methylphenidate's most notable side effect is migraines.
Migraines may appear hours after taking the drug.
Methylphenidate is a central nervous system (CNS) stimulant.
It is claimed to have a calming effect on many children who
have ADHD, reducing impulsive behavior and the tendency to
act out, and helps them concentrate on schoolwork and other
tasks.
Some researchers have theorized that ADHD is caused by a
dopamine imbalance in the brains of those affected. MPH is a
dopamine re-uptake inhibitor, which means that it increases
the level of the dopamine neurotransmitter in the brain by
partially blocking the transporters that remove it from the
synapses.
In the United States, methylphenidate is classified as a
Schedule II controlled substance, the designation used for
substances that have a recognized medical value but which
have a high potential for abuse because of their addictive
potential. Some people abuse MPH by crushing the tablets and
snorting them, the high resulting from the increased rate of
dopamine transporter blockade due to quicker absorption into
the bloodstream. In this manner, the effect of Ritalin is similar
to that of cocaine or amphetamine and such abuse can lead to
addiction. When taken orally in prescribed doses, MPH has a
low addiction liability and rarely produces a high.
Methylphenidate has been used illegally by students for whom
the drug has not been prescribed, to assist with coursework
and examinations.
Some consider the treatment of children with stimulant
medication to be controversial since the number of children
taking them has increased dramatically over the years.
However, criticism that methylphenidate is over-prescribed
may be unfounded; the incidence of ADHD is believed to be
between three and five percent of the population, while the
number of children in America taking Ritalin is estimated at one
to two percent.
Some have argued that prescription of stimulant medications
sets children up for future addictions. However, recent
research suggests that boys with ADHD who are treated with
stimulants like MPH are actually less likely to abuse drugs
including alcohol later in life.
As long-term use of methylphenidate was relatively uncommon
before the 1990s, the long-term neurological effects are not
well researched.
As documented for amphetamines, the potential of
methylphenidate use over many years causing permanent
neurological damage to dopaminergic systems exists at least
in theory.
Researchers have also looked into the role of methylphenidate
in affecting stature, with some studies finding slight decreases
in height acceleration. Other studies indicate height may
normalize by adolescence.
Both the United States Drug Enforcement Administration
(DEA) and the United Nations International Narcotics Control
Board have expressed concern about the ease with which
legally prescribed MPH is diverted to the illicit market.
According to the DEA, the increased use of this substance
[MPH] for the treatment of ADHD has paralleled an increase in
its abuse among adolescents and young adults who crush
these tablets and snort the powder to get high. Youngsters
have little difficulty obtaining methylphenidate from classmates
or friends who have been prescribed it.
At a Rhode Island middle school, half a dozen sixth graders
were charged with drug possession or distribution. Five
teenagers at a Florida high school faced similar charges.
With 11 million Ritalin prescriptions given out every year,
there's plenty circulating in what has become a schoolyard
black market. Many students who are prescribed the drug are
selling it to their peers for a few dollars a pill.
A recent study in Massachusetts found that of 3,500 high
school students, almost 13% admitted to using someone
else's Ritalin.
Ritalin, snorted or injected, is not only addictive, but can also
be deadly (can cause tremors, palpitations, hypertension,
convulsions).
The DEA is set to distribute a pamphlet to schools warning
about potential Ritalin abuse and recommending tight storage
and supervision to stem the problem.
Ritalin: Side Effects and an Alternative to Ritalin
It has been our opinion for years that Ritalin is a good
medication. But it can cause problems, sometimes serious side
effects, and must be used with caution.
Recent FDA warnings are starting to make us wonder about
recommending Ritalin these days. The evidence seems to be
mounting against it.
Our Clinical Director Dr. Cowan has worked with over 1,000
children and teens with ADHD over the past 20 years, and
hundreds of those ADHD patients were treated with Ritalin.
For about a third of those patients Ritalin made a "day and
night" difference. For another third Ritalin was "helpful." For
the rest, Ritalin either didn't help significantly, or it actually
caused problems. For a few ADHD kids there were significant
side effects ranging from loss of appetite, to seizures.
Most of the Ritalin side effect problems observed over the
years were due to physicians not being careful with the
prescriptions, and prescribing too much Ritalin per dose,
especially when first beginning treatment.
Other problems were observed when parents would continue
to give the Ritalin to their ADHD kid even when they saw that
the medication was causing the child problems. Ritalin is a
powerful tool and must be used carefully, if used at all.
Tip for Parents: The short-acting pill is better than the timed-
release pill. Also, the brand name "Ritalin" is much superior to
the generic "Methylphenidate." Always begin your "trial" of
medication with the real stuff. If that works, then feel free to
see if the generic will work as well as the "real stuff." Ritalin
begins to work in about 15 or 20 minutes. It peaks in
effectiveness at 1.5 to 2.5 hours, and lasts for about 3.5 to
4.0 hours.
More Ritalin Side Effects—
Some kids have "withdrawals" or a "trough
period" from coming off of the Ritalin dose
at about the 4 hour mark.
They may become irritable, tearful, emotional, or bratty. This
lasts for about 15 minutes, and tends to be worse with Ritalin
doses of 15 mg. or more.
The best remedy for this that we've found is a 12 oz.
Mountain Dew at about the 3.0 hour mark. The caffeine
"deflects" or "flattens out" the angle of withdrawal. This trick
works well.
We have seen hundreds of kids benefit greatly from Ritalin.
But doctors and parents must be observant and conservative.
We have also seen some horror stories with Ritalin. Start
slowly and cautiously. It is not a toy. And remember, there are
other things that you can do that work as well as Ritalin, and
are healthy for you!
Is Ritalin Dangerous?
Here is a link to a site that is strongly opposed to Ritalin
use, as the author, Mr. Lawrence Smith, states that his child
died as the result of its use.
He claims that there are about 20 deaths reported each year
to the FDA's MedWatch program from Ritalin. Although it is
hard to believe everything that is on the internet, I do think
that you should at least take a minute to look over his site
and consider the information.
Here is an email that Mr. Smith sent to me
in 2002:
Monday, February 25, 2002 9:35pm
Dear Webmaster,
My 14 year old son Matthew died from Ritalin use.
We were threatened by the school social worker that If we didn't comply
with their diagnosis and take him to the doctor and get him on some
Ritalin, that we could be charged with neglecting his educational and
emotional needs.
They explained ADHD as though it was a objective disorder. Well I have
sense done much research to find out that is a bunch of hog wash. I
have created the website www.ritalindeath.com to inform parents of the
truth behind ADHD.
With the horrible experience of losing my son from the medication Ritalin.
It has caused me to get to the bottom of it, and find out what the heck is
going on, and see what I can do to help other families from going through
the same hell we are now living.
My site tells our story in detail, with much information that I have
compiled. I hope that you will conceder putting my website on yours as a
link?
I feel that it is very important that parents get more information than
just a little selective information paid for by drug companies.
Sincerely,
Lawrence Smith
There are Other Choices—
Look at this chart comparing Ritalin to ATTEND and to EEG
Biofeedback treatment...
Ritalin is very effective. Ritalin works somewhat differently in
the brain than do the amphetamines like Dexedrine or
ADDerall. Ritalin seems to primarily impact on longer term
vesicular storage of Dopamine, while amphetamines primarily
impact the pool of newly synthesized Dopamine. It also has a
different effect on Norepinepherine.
Attend is also effective. It has amino acids, essential fatty
acids, phospholipids, homeopathic medicines, and more. It is
healthy and effective. And it does not require a prescription,
and comes with a no-risk trial policy second to none. It either
works - or it is free.
The main side effects of Ritalin that we have observed are loss
of appetite (feed a protein shake twice a day to help keep
weight up), some irritability or anger (as when you have had
too much caffeine), possible short term growth inhibition
(though long-term this may not be a problem). Remember,
every medication has possible bad side effects, so always
closely monitor your child when taking medications!
If there is a problem, don't give the next dose, and call your
doctor right away.
==> Are there any natural ways to treat ADHD?
FDA Black Box Warning
Labels on ADHD
Medications—
After much debate the following
medications carry the "black box
warnings" on the labels of the bottles.
These are the strongest warnings
that the FDA requires (a step away
from pulling the medications of the
shelves):
• Adderall Tablets (mixed salts of
a single entity amphetamine product)
• Adderall XR (mixed salts of a
single entity amphetamine product)
Extended-Release Capsules
• Concerta (methylphenidate
hydrochloride) Extended-Release
Tablets
• Daytrana (methylphenidate)
Transdermal System
• Desoxyn (methamphetamine
hydrochloride) Tablets Label (will be
updated soon)
• Dexedrine (dextroamphetamine
sulfate) Spansule Capsules and
Tablets
• Focalin (dexmethylphenidate
hydrochloride) Tablets
• Focalin XR (dexmethylphenidate
hydrochloride) Extended-Release
Capsules
• Metadate CD (methylphenidate
hydrochloride) Extended-Release
Capsules
• Methylin (methylphenidate
hydrochloride) Oral Solution
• Methylin (methylphenidate
hydrochloride) Chewable Tablets
• Ritalin (methylphenidate
hydrochloride) Tablets
• Ritalin SR (methylphenidate
hydrochloride) Sustained-Release
Tablets
• Ritalin LA (methylphenidate
hydrochloride) Extended-Release
Capsules
• Strattera (atomoxetine
hydrochloride) Capsules
Warnings for Amphetamine,
Dextroamphetamine,
Lisdexamfetamine dismesylate,
Methamphetamine, Mixed Salts of a
Single Entity Amphetamine
Products—
Adderall, Adderall XR, Desoxyn, and
Dexedrine (SR):
• Drug dependence:
Administration of amphetmaines for
prolonged periods of time may lead to
drug dependence and must be
avoided.
• High abuse/diversion potential:
Amphetamines have a high potential
for abuse. Particular attention should
be paid to the possibility of subjects
obtaining amphetamines for non-
therapeutic use or distribution to
others, and the drugs should be
prescribed or dispensed sparingly.
• Serious Adverse Events: Misuse
of amphetamines may cause sudden
death and serious cardiovascular
adverse events .
Warnings for Dexmethylphenidate,
and Methylphenidate Medications—
Ritalin, Ritalin LA, Ritalin SR,
Concerta, Daytrana, Desoxyn,
Focalin, Metadate, Methylin:
All Dexmethylphenidate,
Methylphenidate Products
• Chronic abusive use can lead to
a marked tolerance and
psychological dependence with
varying degree of abnormal behavior.
• Frank psychotic episodes can
occur, especially with parental abuse.
Methylphenidate Products: Concerta,
Metadate, Ritalin, Daytrana and
Dexmethylphenidate Products: Focalin
o Careful supervision required
during drug withdrawal from abusive
use since severe depression may
occur.
o Should be given cautiously to
patients with a history of drug
dependence or alcoholism.
o Withdrawal following chronic
therapeutic use may unmask
symptoms of the underlying disorder
that may require follow-up.
Methylphenidate Products: Methylin
Products
o Careful supervision required
during drug withdrawal, since severe
depression as well as the effects of
chronic over-activity can be unmasked.
o Long term follow-up may be
required because of the patient's
basic personality disturbances.
o Should be given cautiously to
emotionally unstable patients, such
as those with a history of drug
dependence or alcoholism, because
such patients may increase dosage
on their own initiative.
Strattera Atomoxetine—
Strattera Suicidal Ideation in Children
and Adults:
• Anyone considering the use of
atomoxetine in a child or adolescent
must balance this risk with the clinical
need.
• Atomoxetine increased the risk
of suicidal ideation in short-term
studies in children or adolescents
with attention-deficit/hyperactivity
disorder (ADHD).
• Families and caregivers should
be advised of the need for close
observation and communication with
the prescriber.
• Patients who are started on
therapy should be monitored closely
for suicidality (suicidal thinking and
behavior), clinical worsening, or
unusual changes in behavior.
Labels on ADHD
Medications—
After much debate the following
medications carry the "black box
warnings" on the labels of the bottles.
These are the strongest warnings
that the FDA requires (a step away
from pulling the medications of the
shelves):
• Adderall Tablets (mixed salts of
a single entity amphetamine product)
• Adderall XR (mixed salts of a
single entity amphetamine product)
Extended-Release Capsules
• Concerta (methylphenidate
hydrochloride) Extended-Release
Tablets
• Daytrana (methylphenidate)
Transdermal System
• Desoxyn (methamphetamine
hydrochloride) Tablets Label (will be
updated soon)
• Dexedrine (dextroamphetamine
sulfate) Spansule Capsules and
Tablets
• Focalin (dexmethylphenidate
hydrochloride) Tablets
• Focalin XR (dexmethylphenidate
hydrochloride) Extended-Release
Capsules
• Metadate CD (methylphenidate
hydrochloride) Extended-Release
Capsules
• Methylin (methylphenidate
hydrochloride) Oral Solution
• Methylin (methylphenidate
hydrochloride) Chewable Tablets
• Ritalin (methylphenidate
hydrochloride) Tablets
• Ritalin SR (methylphenidate
hydrochloride) Sustained-Release
Tablets
• Ritalin LA (methylphenidate
hydrochloride) Extended-Release
Capsules
• Strattera (atomoxetine
hydrochloride) Capsules
Warnings for Amphetamine,
Dextroamphetamine,
Lisdexamfetamine dismesylate,
Methamphetamine, Mixed Salts of a
Single Entity Amphetamine
Products—
Adderall, Adderall XR, Desoxyn, and
Dexedrine (SR):
• Drug dependence:
Administration of amphetmaines for
prolonged periods of time may lead to
drug dependence and must be
avoided.
• High abuse/diversion potential:
Amphetamines have a high potential
for abuse. Particular attention should
be paid to the possibility of subjects
obtaining amphetamines for non-
therapeutic use or distribution to
others, and the drugs should be
prescribed or dispensed sparingly.
• Serious Adverse Events: Misuse
of amphetamines may cause sudden
death and serious cardiovascular
adverse events .
Warnings for Dexmethylphenidate,
and Methylphenidate Medications—
Ritalin, Ritalin LA, Ritalin SR,
Concerta, Daytrana, Desoxyn,
Focalin, Metadate, Methylin:
All Dexmethylphenidate,
Methylphenidate Products
• Chronic abusive use can lead to
a marked tolerance and
psychological dependence with
varying degree of abnormal behavior.
• Frank psychotic episodes can
occur, especially with parental abuse.
Methylphenidate Products: Concerta,
Metadate, Ritalin, Daytrana and
Dexmethylphenidate Products: Focalin
o Careful supervision required
during drug withdrawal from abusive
use since severe depression may
occur.
o Should be given cautiously to
patients with a history of drug
dependence or alcoholism.
o Withdrawal following chronic
therapeutic use may unmask
symptoms of the underlying disorder
that may require follow-up.
Methylphenidate Products: Methylin
Products
o Careful supervision required
during drug withdrawal, since severe
depression as well as the effects of
chronic over-activity can be unmasked.
o Long term follow-up may be
required because of the patient's
basic personality disturbances.
o Should be given cautiously to
emotionally unstable patients, such
as those with a history of drug
dependence or alcoholism, because
such patients may increase dosage
on their own initiative.
Strattera Atomoxetine—
Strattera Suicidal Ideation in Children
and Adults:
• Anyone considering the use of
atomoxetine in a child or adolescent
must balance this risk with the clinical
need.
• Atomoxetine increased the risk
of suicidal ideation in short-term
studies in children or adolescents
with attention-deficit/hyperactivity
disorder (ADHD).
• Families and caregivers should
be advised of the need for close
observation and communication with
the prescriber.
• Patients who are started on
therapy should be monitored closely
for suicidality (suicidal thinking and
behavior), clinical worsening, or
unusual changes in behavior.
