ADD/ADHD and Ritalin Introduction The use of medication for ADD/ADHD began over fifty years ago. Since 1937 stimulant medication has shown to be effective, but was not used more widely until 1957 or so. In 1957 Ritalin was introduced and many controlled studies have have tested the safety and effectiveness of this medication. As Grad L. Flick (1998) reported in his book "ADD/ADHD Behavior Change Resource Kit. In the 1980's the Church of Scientology started a strong campaign against Ritalin. Ritalin was implicated in being associated with brain damage, high blood pressure, confusion, murder, emotional disorders, Tourette's, neurological seizures, agitation, depression, and suicide. The professional community was determined that the psychiatrists were considered "money hungry." DuPaul and Stoner noted 750,000 children that have been placed on a stimulant medication (Flick, 1998). A review done by Miller (1996) of over 155 controlled studies with over 5000 children being treated by medication stimulants are effective for about 70% of the time with a 60-90% of effectiveness. Stimulants are used predominantly to reduce restlessness, help children to maintain their work effort so they may complete tasks, enhance the accuracy of their work and their ability to plan tasks, improve their overall productivity in the classroom. By taking the stimulant it also helps to decrease in impulsivity and disruptiveness, along with the ability to control emotions, better interpersonal relationships, better handwriting, and a general calmness. Some of the other side effects include more positive relationships with peers, siblings, and family along with an enhanced self-esteem (Flick, 1998). References: Flick, G. L. (1998). ADD/ADHD Behavior Change Resource Kit. New York: The Center For Applied Research In Education. Chemistry of Ritalin and its route through the body Kristi Shanoff Methylphenidate Hydrochloride (more commonly known as Ritalin) is classified as both a piperidine derivative (Loeb et al., 1992) and an amphetamine (Hales et al., 1994) which serves as a central nervous system stimulant by blocking the reuptake of dopaminergic neurotransmitters (USP DI, 1989). This psychostimulant drug also stimulates the respiratory system (Wilson et al., 1999). The chemical name of methylphenidate is more specifically 2 piperidineacetic acid, alpha phenyl, methyl ester, and hydrochloride. Its molecular formula is C14H19NO2HCl. Additionally, it is a white, odorless, fine crystalline powder (USP DI, 1989). Its chemical structure is shown below (Ambre et al., 1993): (Please see attachment).
Ritalin is often used in treating attention deficit/hyperactivity disorder
(ADHD). Most commonly, it is administered to the patient orally in the form of
a pill. Additionally, the patient is usually instructed to consume the pill
before meals. (Research was conducted in order to determine whether taking
Ritalin a half an hour before breakfast versus taking Ritalin with breakfast
produced any notable differences in the behavioral, cognitive, or
electrophysiological affects of Ritalin. The results revealed that there were
no significant differences.) (Ambre et al., 1993).
Once ingested, Ritalin enters the gastro intestinal (GI) track where it is
absorbed by the lining in the stomach and the microvilli in the small intestine
(Hickman et al., 2001) (Wilson, 1999). After absorption, Ritalin is transported
via the bloodstream to the brain. This transport of Ritalin through the
bloodstream to the brain happens both completely and relatively quickly because
Ritalin is freely soluble in water, allowing Ritalin's absorption into the
bloodstream to occur quickly (USP DI, 1989). Additionally, after
administration, Ritalin reaches peak plasma concentration (concentration in the
bloodstream) within two hours (Ambre et al., 1993), sometimes reaching peak
concentration even within one hour. Also, once in the bloodstream, Ritalin's
duration of action is about 4-6 hours and up to 8 hours in extended release
tablets (Loeb et al., 1992). Additionally, once Ritalin passes through the
blood brain barrier (a barrier in the brain which limits what substances can
enter the brain (Carlson, 2001)), the Ritalin begins to primarily affect the
cerebral cortex and the reticular activating system (Loeb et al., 1992).
Regarding elimination, methylphenidate hydrochloride is filtered through the
liver where it is metabolized (Loeb et al., 1992). It is also hydrolyzed to
become ritalinic acid, and in this form, it is excreted in urine (Ambre et al.,
1993).
In light of this information, it is extremely important to administer Ritalin
to patients in appropriate dosages and at appropriate times of day because of
both the many side effects of Ritalin (both behavioral and physiological which
will be discussed later) and because of its duration of action in the body.
First of all, administering Ritalin to children diagnosed with ADD (attention
deficit disorder) or ADHD under the age of 6 is not recommended, especially
because Ritalin has been associated with growth suppression. Secondly, because
of Ritalin's association with insomnia, it is recommended that Ritalin be taken
a decent amount of hours before the patient is planning on going to bed (Loeb
et al., 1992). Lastly, the optimal dosage of Ritalin varies with each patient;
some patients may require 10 mg of Ritalin per meal, while another may require
only 5 mg. Because the dosage of Ritalin varies with each patient's condition,
it is very important that patient's dosage is both carefully and accurately
determined (Ambre et al., 1993).
An additional aspect of Ritalin's chemistry that elicits attention is the fact
that Ritalin is an amphetamine, a substance that has an addictive nature
because of its affects on the body. Because of this, patients may start to
abuse Ritalin; the patient may even go so far as to grind up Ritalin and
administer it to him/herself by injection. Thus, it is important to monitor
the patient, checking for signs of abuse (Loeb et al., 1992). Signs of Ritalin
abuse are similar to those of heroine or cocaine. In cases where the patient
is suspected of overdosing, acidification of the urine helps elimination (Hales
et al., 1994).
Plus, because of Ritalin's chemistry, tolerance of Ritalin may build up,
causing psychic dependence. In turn, withdrawal may result when the dosage is
reduced or terminated (Wilson et al., 1999); patients using Ritalin daily or
intravenously may even need hospitalization for depression, suicidal tendencies
during withdrawal, or psychosis (Hales et al., 1994).
Something else to consider when prescribing Ritalin to a patient are the
different drugs Ritalin interacts with. One such drug is caffeine. When there
is caffeine in the patient's system, Ritalin's affect on the central nervous
system may be heightened because caffeine is also a CNS stimulant. Their
combined stimulation of the central nervous system could be dangerous, and
therefore it is strongly advised that caffeine and Ritalin are not taken
concomitantly (Loeb et al., 1992).
Other drugs Ritalin interacts with are the monoamine oxidase (MAO) inhibitors.
MAO inhibitors are often used in the treatment of major depression. Studies
have shown that when Ritalin is administered to a patient also receiving MAO
inhibitors, the plasma concentration of MAO inhibitors in the bloodstream
increases, thus affecting the way they will change the patient's behavior.
Also, because both MAO inhibitors and Ritalin both affect the activity of the
same neurotransmitters in the central nervous system (although in different
ways), the administration of these two drugs simultaneously should be
approached very cautiously (Ambre et al., 1993). Plus, simultaneous
administration could cause severe hypertension (high blood pressure)(Loeb et
al., 1992).
References
Amato, C.J. (1998) The World's Easiest Guide to Using the APA: A User-
Friendly Manual for Formatting Research Papers According to the American
Psychological Association Style Guide (2nd ed.). Westminster: Stargazer
Publishing Company.
Ambre, J.J., Bennet, D.R., Cranston, J.W., Dickinson, B.D., Glade, M.J., McCann
M.A., Pang, D.C., Proudfit, C.M., Rapoza, N.P., Ratko, T.A., Seidenfield J.,
Smith, S.J., (1993). Drugs used in mood disorders: Monoamine Oxidase (MAO)
Inhibitors. In Drug Evaluation Annual, 1994 (pp. 299-301). (Rodgers, B.J.,
McVeigh, S., Meyer, M., Schwartz, J.M., Chang, J., Laan, S.V., Grosso, V.,
Mayo, M.A. ed.) Milwaukee: American Medical Association.
Ambre, J.J., Bennet, D.R., Cranston, J.W., Dickinson, B.D., Glade, M.J., McCann
M.A., Pang, D.C., Proudfit, C.M., Rapoza, N.P., Ratko, T.A., Seidenfield J.,
Smith, S.J., (1993). Drugs used in other mental disorders: Methylphenidate
hydrochloride. In Drug Evaluation Annual, 1994 (pp. 339-340). (Rodgers, B.J.,
McVeigh, S., Meyer, M., Schwartz, J.M., Chang, J., Laan, S.V., Grosso, V.,
Mayo, M.A. ed.) Milwaukee: American Medical Association.
Carlson, N.R. (2001). Physiology of Behavior. (7th ed.) Boston: Allyn and
Bacon.
Hales, R.E., Yudofsky, S.C., Talbott, J.A. (1994). Alcohol and other
psychoactive substance use disorders: Amphetamines. In The American
Psychiatric Press Textbook of Psychiatry. (2nd ed.) (pp. 394-395).
Washington DC: American Psychiatric Press, Inc.
Hickman, C.P., Roberts, L.S., Larson, A. (2001). Integrated Principles of
Zoology. (11th ed.) New York: McGraw Hill Companies Inc.
Loeb, S., Hamilton, H.K., McVan, B., Hubbard, J., Blake, G.J., Cray, J.V.,
Ginnona, T.A., Peters, S., Buschini, M., Stangl, M., Perry, R., Bernhardt, H.,
Knauss, D., Weider, R., Kosten, D., Paluba, D., Bergman, L., Biletz, J.R.,
Marron, P., Rantz, R., Rosenberger, V., Meiris, D., Landis, T.A., Suter, J.,
Hayman, C., DeRosa, M., Lane, B., Madden, M. (1992). Methylphenidate
hydrochloride: Ritalin, Ritalin SR. In Handbook of Psychotrophic Drugs. (pp.
174-176). Springhouse: Springhouse Corporation.
Methylphenidate (Systemic). (1989). In Drug Information for the Health Care
Professional, USP DI. (9th ed., Vol. 1B, pp. 1636-1638). Rockville: The
United States Pharmacopeial Convention, Inc.
Wilson, B.A., Shannon, M.T., Stang, C.L. (1999). Methylphenidate
hydrochloride. In Nurses Drug Guide. Stanford: Appleton and Longe.
SYNAPTIC TRANSMITTERS
TOM CAVE
To understand the effect of psycho stimulants such as Ritalin, one must
determine the means by which receptor and transporter proteins interact and how
their maladaptation underlies abnormal behavior.
The process of neurotransmission begins with the release of a ligand, such as
dopamine, from the presynaptic membrane and its subsequent binding to the G
protein coupled receptors embedded in the postsynaptic membrane. These G
proteins then active a biochemical, intracellular change. Thus, various
proteins must interact with each other in order to manifest cellular
communication and regulate responses to neurotransmitter. This interaction and
regulation has an important impact on the role of the central nervous system
and its response to stimulants.
Neurotransmitter transporters are embedded in the presynaptic membrane and
remove excess transmitters from the synaptic cleft for recycling. This in
effect regulates the intensity and duration of synaptic transmission. This
area also becomes the site for the aberrant behavior of the neurotransmitters
due to the presence of therapeutic drugs, such as Ritalin.
To better understand the relationship between transporters and receptors and
the role of psycho stimulants, researchers at Duke University generated a line
of mice in which the dopamine transporter has been genetically inactivated (DAT
KO). This deactivation created certain physiological changes that included the
following: the down regulation of G protein coupled receptors associated with
dopamine binding; changes in the synthesis, degradation, storage, and release
of the neurotransmitter. Since there were no longer any dopamine transporters
to reabsorb residual dopamine into the terminal bouton through the presynaptic
membrane, there became an oversupply of dopamine causing restlessness and
hyperactivity, an impairment in cognitive performances, and an inability to
suppress inappropriate impulses. "The phenotypic and pharmacological
properties of DAT KO mice are reminiscent of certain manifestations of
attention deficit hyperactivity disorder in children." (Caron, Medical
Institute News, February 7, 2001). Subsequent treatment with Ritalin led to a
decrease in hyperactivity even though the DAT protein had been ablated in these
mice.
The unexpected result of Ritalin causing an abatement in hyperactivity in mice
in which the dopamine transporter had been genetically eliminated led the
researchers to suspect that Ritalin exerted its effects through a transmitter
other than dopamine. Prozac (a serotonin reuptake inhibitor) was administered
to the genetically altered mice, resulting in dramatic declines in
hyperactivity. This suggests that the paradoxical calming effect of stimulants
is a result of the increase in the level of serotonin, thus restoring the
balance between the neurotransmitters of serotonin and dopamine. Consequently,
hyperactivity is a result of the disturbance of the relationship between these
two transmitters, and not just in the reuptake blocking of dopamine as had been
previously thought.
"The brain has 15 types of receptors that bind to serotonin. Scientists are
now trying to determine which specific serotonin receptors mediate the effects
of Ritalin." (Caron, Medical Institute News, January 15, 1999). The goal of
research then becomes the finding of a replacement for Ritalin that targets a
specific subset of receptors. Compounds that would act more specifically would
be safer by reducing side effects and be more effective in treating attention
deficit hyperactivity disorder.
References
http://www.hhmi.org/news/caron2.
http://www.hhmi.org/research/investigators/caron.html
(edited)
Physiological changes on the whole body.
By, Alison Edgar
The effects of Ritalin on the body can cause many different physiological
changes to occur. These changes can vary from very dramatic, to just some
slight physical side effects. There is so much information regarding the
effect that Ritalin has on the body, it would be hard for the average consumer
to get an unbiased opinion on how it affects the body physiologically. Most of
the data currently out on the effects of Ritalin show the highly addictive
qualities of the drug, as well as the huge range of physiological effects it
has on the brain functioning. Ritalin has been shown to have impact within the
brain on biochemical reactions, brain structure, and brain function.
Ritalin causes many changes in the brains neurotransmitter systems. It causes
the three neurotransmitters, Dopamine, Serotonin, and Norepinephrine to have an
increased role in the synapse. In having an increased role, these transmitters
will have an impact on the processes that effect thinking, feeling and acting
(Breggin, 1998). It effects the neurotransmitters in two ways, first by
increasing the amount of neurotransmitter dropped into the synapse, and second
by making it remain longer in that space (Breggin, 1998). Since these three
neurotransmitters are increased it causes the functioning of the three to be
prolonged, causing many physiological effects throughout the brain. The effect
of increased Dopamine is to suppress spontaneous behavior in favor of rote
performance (Breggin, 1998). Since dopamine nerves can't reach the
hypothalamus and pituitary gland, where they control a large amount of hormonal
processes, it can also have an effect on growth and reproductive functioning
(Breggin, 1998). The second neurotransmitter affected is Serotonin. Ritalin
can also increase hyperactivity in the serotonin transmitter system. The
effect of this can lead to severe mental aberrations, including psychosis with
hallucinations, and delusions (Breggin, 1998). The last neurotransmitter
affected is Norepinephrine. ` Most brain functions are effected by this
neurotransmitter. The Ritalin caused over activity in the cardiovascular
system, as well as leading to symptoms of drug withdrawal in this system
(Breggin, 1998). The effect of the drug on the neurotransmitters is an overall
increase in the activity of these transmitters, leading to many physiological
effects.
Ritalin can also cause many other brain dysfunctions. One of them is the
permanent loss of brain tissue. In a study conducted by Henry A. Masrallah, it
was found that there was a 50% shrinkage in the brain of more than 24 young
adults since childhood. All of these adults had been treated with stimulants
since childhood (Breggin, 1998). In two more studies it was also proven that
children with ADHA had brains that were and average of 4% smaller than other
children, and that some children and a smaller corpus callosum than other
children. All of these children had been on Ritalin. This shows that Ritalin
not only affects the biochemistry of the brain, but also the functioning and
size of the brain.
Ritalin is known to be a highly addictive drug. It is known as a
methylphenidate hydrochloride, a Schedule 11 drug that is classified by the
Drug
Enforcement Agency as a potent and potentially addictive substance (Nortan,
1999). Stimulants like Ritalin can cause seizures, cardiac arrhythmias, and
psychotic symptoms such as hallucinations and delusions (Breggin, 1998). This
happens because the body becomes desensitized to Ritalin, causing the child to
have to take more to have the same affect, which causes physical addiction.
One
of the reasons so much is taken is that it only stays in the system for four
hours. Some other effects of Ritalin addiction are strokes, hyperthermia,
hypertension, and seizures (Ulman, Ulman, 1996). This is another aspect of the
dramatic physiological affects of Ritalin.
Ritalin can also affect brain functioning by causing a dramatic loss of blood
flow to the brain. A study conducted by Brookhaven National Laboratory in
Upton, New York, measured the effect of Ritalin on blood flow in normal
volunteers. They found that Ritalin decreased the overall blood flow to the
brain. The loss was 23% to 30% in all areas of the brain (Breggin, 1998).
This
type of blood loss could be related to the drug's impact on dopamine. This
blood loss lasted for 30 minutes which could have a sever impact on brain
functioning. Further research would have to be conducted to gain more
knowledge
of the long term impact on this blood loss.
Ritalin has many different physiological affects on the brain. They range from
affecting the neurotransmitters, to how it is highly addictive. We will not
know the long lasting effects until more research in this area is conducted.
The
short term effects of Ritalin are to calm a child who has Attention Deficit
Disorder. However, the long term effects are still unknown and surrounded by
much controversy. There is a large amount of literature on the subject, but
one
must wade through it to find the effectiveness, or ineffectiveness it has on
treating children who have Attention Deficit Disorder.
References
Breggin, P.R. (1998). Talking Back to Ritalin. Common Courage Press.
DeGrandpre, R. (1999). Ritalin Nation. New York, New York: W.W. Norton
Company
Inc..
Ullman, J.R., Ullman, R. (1996). Ritalin Free Kids. Prima Publishing.
Primary Behavioral Changes
Jennifer Crawley
Every parent has concerns about their child's abnormal behavioral. Before their
child takes any kind of medication they may ask themselves, Are these drugs
dangerous? Is Ritalin an addictive drug? First of all, when a child is
diagnosed with ADHD in all most all cases the doctor will prescribe a drug
named Ritalin. Just like any other drug, it comes with behavior changes,
difficulties and myths.
One myth people might hear about is the drug going to make the children "high"
as other drugs do and are they addictive? First of all, their has been no
reported cases of addiction or serious drug dependence to date with Ritalin or
any other drug. When an adult takes Ritalin some of them may have a sense of
evaluated mood, euphoria or excessive well being, but in children it is rare.
Some children do experience mood changes from happiness to sadness, but only
occurs with taking a high dosage of Ritalin. There are many myths about the
drug called Ritalin but it has been used since early 1970's. Some people may
say that it has come along way and is more dependable now.
I believe one of the main focuses about Ritalin is what exactly does it do to
help behaviors in adults, adolescents and children. Ritalin produces positive
effects on sustained attention and persistence of effect to work. It also
reduces restlessness and gross motor activity. In many cases the child's
attention to assign to do class work is so greatly improved that his or her
behavior appears normal. "Within about two weeks, the teacher said I was
completing my homework, making good grades, and feeling good about myself"
(Barkley, 1995). Numerous studies have been conducted to prove that Ritalin
does help the learning and academic performance. They have proven that the
medicine is very likely to improve a child's attention, impulse control, fine
motor coordination and reaction time. Some children may show improvements in
their short-term memory. It turns out that the medication seems to help
children perform more efficiently and in a more organized manner. It doesn't
exactly improve intelligence, it helps a child what to remember what he or she
already knows. In fact, the drug helps to get their behavior under control and
concentrate on tasks for example homework.
Does the medicine change their social behavior? Ritalin changes their all
around behavior. Children improve their social interactions with their parents,
teachers and peers. Like I said before, children can stay focused and pay
attention to elders, by that I mean a child is able to comply with a parent's
commands and to maintain that compliance over time. In some cases a child can
communicate better, it has been proven that by giving a hyperactive child the
stimulate drug Ritalin and found on immediate 30% reduction in the speech of
the hyperactive children.
In adolescents with higher dosages resulting in the most beneficial response,
with high academic and laboratory measures of attention and impulsivity. The
overall response rate is 75% was reported.
In adults it also indicates effectiveness but with perhaps a reduced response
rate. Whereas methylphenidate (Ritalin) is at least 70% effective in children,
response rates appears to be somewhat lower at 50% in adults.
When taken any level of medication there can some difficulties. In infants and
toddlers, for instance infants may experience neurological dysfunction,
overaggressive/oppositional behaviors, short attention span, low threshold of
frustration, temper tantrums, sleep disorders and accident proneness.
In adolescent and high school students difficulties are high level of anger and
frustration, poor self esteem, mood disorders, inappropriate social skills,
confusion about goals and future, lack of perseverance (dropouts), denial and
poor academic achievement.
In adult the difficulties are disorganization, forgetfulness, spectrum of mood
disorders, feeling of never having accomplishment what one is capable of doing,
procrastination, anger/low frustration of tolerance, alcoholism and drug abuse.
All of these results will vary to person to person. It is not exactly a
guarantee that a child, adolescents or even an adult will improve by just
taking Ritalin. You may have to take more that one action to improve one's
behavior.
References
Barkley, Russell A. (1995). The complete, Authoritative guide for parents.
Taking charge of ADHD, 250-260.
Quinn, Patricia O.(1997).Diagnosis and Treatment from Infancy to Adulthood.
Attention Deficit Disorder,13, 205-209.
Side Effects of Ritalin (Methylphenidate)
Laramie Lesina
Ritalin is the brand name for Methylphenidate, which is a stimulant commonly
prescribed to children and adults with attention deficit/hyperactive disorder
(Leland & Biddle, 1995). Ritalin has been classified as a Central Nervous
System Stimulant, and is manufactured by Ciba (Psychopharmacology, 1997). The
major side effects include the following: most commonly, nervousness and
sleeplessness. Others may include loss of appetite, weight loss, nausea,
dizziness, heart palpitations, increased blood pressure, stomach upset,
(Psychopharmacology, 1997). Ritalin should not be used in children under 6
years
of age, since safety and efficiency in this group have not been established
(Long, 1995-1999). Although a causal relationship has not been established,
suppression of growth (i.e. weight gain and /or height) has been reported with
the long-term use of stimulants in children. Therefore, patients requiring
long-term therapy should be carefully monitored. In addition, the use of "Drug
Holidays" is recommended, that is, withholding the drug on weekends and during
school holidays in as much as the clinical situation permits (Long, 1995-1999).
" Parents and teachers and even doctors have been badly misled by drug company
marketing practices," " Drug companies have targeted children as a big market
likely to boost profits— and children are suffering as a result" (Breggin).
Although previously stated a more extensive detailed list of possible side
effects is as follows; According to DR. Breggin, side effects of the drug can
include 1. Decreased blood flow to the brain, an effect recently shown to be
caused by cocaine where it is associated with impaired thinking ability and
memory loss, 2. Disruption of growth hormone, leading to the suppression of
growth in the body and brain of the child, 3. Permanent neurological tics,
including Tourette's Syndrome, 4. Addiction and abuse, including withdrawal
reactions on a daily basis, 5. Psychoses (mania), depression, insomnia,
agitation and social withdrawal, 6. Possible shrinkage (atrophy) or other
permanent physical abnormalities in the brain, 7. Worsening of the very
symptoms the drug is supposed to improve including hyperactivity an
inattention, 8. Decreased ability to learn. Another area in which there may be
concern is in pregnant and lactating women. The use of Ritalin is not
recommended during pregnancy and mothers taking Ritalin should refrain from
breast feeding their infants (Long, 1995-1999).
The five areas in which adverse reactions may occur include the following
identification of the area and the adverse effects that may occur in that
specific region of the human body. Central and Peripheral Nervous System:
Dizziness, drowsiness, headache, and dyskinesia may occur. Isolated cases of
the following have been reported: hyperactivity, convulsions, muscle cramps,
chareo-athetoid movements, tics, or exacerbation of preexisting tics, and
psychotic episodes including hallucinations which subsided when Ritalin was
discontinued. Gastrointestinal: Nausea and abdominal pain may occur at the
start of the treatment and may be alleviated if taken with food.
Cardiovascular: Palpitations, blood pressure and pulse changes (both up and
down), tachycardia, angina and cardiac arrhythmias. Skin and/or
Hypersensitivity: Rash, pruritus, urticaria, fever, arthralgia, and alopecia.
Isolated ases of exfoliative dermatitis, erythema multiforme with
histopathological findings of necrotizing vasculitis, and thrembocytopenic
purpura. Hematologic: Isolated cases of leukopenia, thrombocytopenia and anemia
(Long, 1995-1999).
Along with the side effects, Ritalin also has several downsides when used for
the treatment of ADHD. These seven downsides of Ritalin include 1. Derived from
the same family as cocaine 2.Lasts only four hours 3. Treats only some of the
symptoms of ADHD 4. Provides superficial healing, does not treat the root of
the problem 5. Can cause major side effects 6. Gets children in the habit of
taking drugs 7. May need to be taken over an entire life span ("Health For
You", 1995-1999).
Parents are seldom told that methylphenidate is "speed" that is
pharmacologically classified with amphetamines and causes the very same
effects, side effects and risks. Parents are infrequently informed that like
any for of speed, methylphenidate can often make children anxious and sometimes
cause them to behave in ways that seem "crazy". Most surely parents are not
told about any permanent brain damage from long-term exposure to Ritalin
(Breggin & Breggin, 1995).
Ritalin should be given cautiously to emotionally unstable patients because
drug dependence can occur. Chronically abusive use can lead to marked tolerance
and psychic dependence with varying degrees of abnormal behavior. Frank
psychotic episodes can occur, especially with parental abuse. Careful
supervision is required during drug withdrawal, since severe depression as well
as the effects of chronic over activity can be unmasked. Long-term follow up
may
be required because of patient's basic personality disturbances (Long, 1995-
1999). Signs and symptoms of acute overdose, resulting from CNS over
stimulation
and from excessive sympathomimetic effects, may include the following:
vomiting, agitation, tremors, hyperreflexia, muscle twitching, convulsions (may
be followed by coma), euphoria, confusion, hallucinations, delirium, sweating,
flushing, headache, hyperpyrexia, tachycardia, palpitations, cardiac
arrhythmias, hypertension, mydriasis and dryness of mucous membrane (Long,
1995-1999).
The Federal Drug Enforcement Administration classifies Ritalin as a Schedule
II drug, the most potent category of drugs that can be prescribed (Guffey,
1992). Ritalin may or may not have any or all of the above side effects that
have been listed; close monitoring is essential when the drug is administered.
References:
Breggin, P. (no date). Dangers of Ritalin [Online]. Available:
http://2gohealth.com/dangers_of_ritalin.htm
Breggin, P.,& Breggin, G. (1995). The Hazards of Treating "Attention-
Deficit/Hyperactivity Disorder" with Methylphenidate (Ritalin): The Journal of
College Student Psychotherapy, 10 (2), 55-72. Available:
http://breggin.com/methylphen.html
Guffey, D. (1992). Ritalin: What educators and parents should know! Journal of
Instructional Psychology, 19 (3), 167-170.
Leland, J., & Biddle, N. (1995). A risky Rx for fun. Newsweek, 126 (18) 74.
Long, P. (1995-1999). Methylphenidate. Internaet Mental Health. Available:
www.menatalhealth.com
(1995-1999) Health For You. Ritalin- the side effects Available:
http://home.adelphia.net/~shall/ritalin.html
(1997). Methylphenidate (generic)—Ritalin (brand). Psychopharmacology Update, 8
(1), 4.
Effects reported by users and/or survivors of the use of Ritalin
Sheila Herbst
The effects that Ritalin can have on children vary widely and are not all yet
known like many medications. Not enough long term research has been done on
the long term effects yet to accurately determine the effects whether they are
either harmful of helpful. It is important that parents do not just believe
what they hear about this medication from doctors because all the facts are not
yet known. Marvin J, Fine, Ph.D. (1980) reported in his book "Intervention
with Hyperactive Children A Case Study Approach." The best determined effects
have been shown in case studies to exemplify the use of coordinated school home
programs that employ behavior management principles, to reduce the disruptive
behavior. This school home program has been shown to be sufficiently effective
to enable the discontinuance of medication for some children (Fine, 1980).
More research needs to be determined on and about the effects before to many
assumptions are confused with facts.
Deciding on which stimulant to prescribe is difficult to determine. Some
children will need two doses others will need four doses of medication, due to
the individual response. In the book, Ritalin is not the Answer by David B.
Stein (1999); he describes his personal experience with his 12 year old son
being prescribed Ritalin. His son's heart developed an irregular beat and was
skipping at over 200 beats per minute. Also developing severe abdominal pains
that were diagnosed as irritable bowel syndrome, along with insomnia that was
diagnosed as night terrors and depression. When he was taken to a new
pediatrician he was immediately taken off all the prescribed medications, and
all the symptoms were cleared up (Stein, 1999). When a father, who has a
Ph.D., is a practicing clinical psychologist and college professor of
psychology, is taken advantage of and our children are being hurt we need to be
extremely careful with allowing our children to use medications that are not
needed.
The effects that have been discovered and noted are both in short term and long
term side effects. Short term side effects either occur immediately or within
several weeks of beginning the drug. Long term side effects may not appear for
many years. One of the most dangerous effects that Ritalin can have on our
children is addiction. The Federal Control Act of 1988, classified Ritalin in
Schedule II, this is the same category as cocaine, opium, and morphine. This
shows that it has a high potential risk for abuse and addiction. Due to the
fact that most of the children on this medication are in fact just that, they
are children in elementary school parents need to be aware that Ritalin is
highly addictive.
Once a child is on medication for a certain period of time they may start to
believe that they need this medication to do well in school, pay attention in
class, or to function daily. After a few years on Ritalin this can make a
child feel dependent on the medication and not allowing them to live freely in
some cases. A story about addiction in Stein's book describes the addiction of
a child who was prescribed Ritalin at age 8, which continued to use it until
age 15. At this time he began to experiment with other drugs such as
marijuana, and taking any pills that he could get his hands on that were
available at school.
Encountering Ritalin by Lawerence H. Diller,(1998) M.D. an excerpt from his
book "Running on Ritalin." A personal History about the addictive nature of
Ritalin and it's wide use as a medication for our youth and adults. A student
attending college in the late 1960's and early 1970's knew the popularity of
taking Dexedrine and Benzedrine to stay awake and cram for exams and papers.
One student became a typical casualty of stimulant induced delusion. Taking
"bennies" to help aid in staying up all night to study for a test, he became to
crash just before the big test. Take a few more he thought, so off to the big
test. After the test he felt he had aced it no problem, however when the tests
were returned he had receive an "F." The blue book was returned and when he
looked at what he had written it was a couple of pages crammed with tiny
illegible writing. This is when this student realized how depleted and
confused he had really been, during the test(Diller, 1998).
Ritalin can have many unhealthy effects on youth and adults. An addictive drug
can effect everyone involved with that person. Staying away from Ritalin will
help all ages of people.
References:
Diller, L. H. (1998). Running on Ritalin. New York:
Bantam Books.
Fine, M. J. (1980). Intervention with Hyperactive
Children A Case Study Approach. New York: SP Medical & Scientific Books.
Stein, D. B. (1999). Ritalin is not the Answer. San
Francisco: Jossey-Bass Publishers.
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Copyright © 2001, Dr. John M. Morgan, All rights reserved -
This page last edited March 6, 2001
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